Provider Demographics
NPI:1992525463
Name:FAUSTINO, MAY CHRISTINE FAMUCOL (PMHNP-BC)
Entity type:Individual
Prefix:
First Name:MAY CHRISTINE
Middle Name:FAMUCOL
Last Name:FAUSTINO
Suffix:
Gender:
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23986 ALISO CREEK RD # 835
Mailing Address - Street 2:
Mailing Address - City:LAGUNA NIGUEL
Mailing Address - State:CA
Mailing Address - Zip Code:92677-3908
Mailing Address - Country:US
Mailing Address - Phone:949-313-4041
Mailing Address - Fax:
Practice Address - Street 1:1720 W BALL RD STE 4C
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92804-5591
Practice Address - Country:US
Practice Address - Phone:714-683-1472
Practice Address - Fax:714-683-1473
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-10
Last Update Date:2025-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95032127363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health