Provider Demographics
NPI:1699092189
Name:FAUSTINO, LORETTA
Entity type:Individual
Prefix:
First Name:LORETTA
Middle Name:
Last Name:FAUSTINO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3811 AIRPORT PULLING RD N
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34105-2512
Mailing Address - Country:US
Mailing Address - Phone:239-455-0900
Mailing Address - Fax:866-495-7055
Practice Address - Street 1:1032 PORT ORANGE CT
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34120-2914
Practice Address - Country:US
Practice Address - Phone:239-455-0900
Practice Address - Fax:866-495-7055
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-23
Last Update Date:2010-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCL01082297332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies