Provider Demographics
NPI:1962900852
Name:FAAMAUSILI, CHRIS
Entity type:Individual
Prefix:MR
First Name:CHRIS
Middle Name:
Last Name:FAAMAUSILI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16930 OAK TREE AVE
Mailing Address - Street 2:
Mailing Address - City:COTTONWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:96022-9683
Mailing Address - Country:US
Mailing Address - Phone:916-670-2647
Mailing Address - Fax:
Practice Address - Street 1:5205 ARGO WAY
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95820-5737
Practice Address - Country:US
Practice Address - Phone:916-823-5117
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-25
Last Update Date:2024-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA342700024376G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376G00000XNursing Service Related ProvidersNursing Home Administrator