Organization
PHOENIX OCULOPLASTIC CONSULTANTS, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MISHA FAUSTINA M.D. (MANAGER)
(602) 257-1498
Entity
Organization
Contact information
Practice address
3410 N 4TH AVE, PHOENIX, AZ 85013-3905
(602) 257-1499
(480) 361-3517
Mailing address
4340 E INDIAN SCHOOL RD, SUITE 21-440, PHOENIX, AZ 85018-5360
(602) 257-1498
(480) 361-3517
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
33016
AZ
2082S0099X
Plastic Surgery Within the Head and Neck (Plastic Surgery) Physician
Primary
33016
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1669438057
NPI
—
01
—
1952570194
NPI
—
05
—
608730
—
AZ
05
—
868672
—
AZ
Enumeration date
11/08/2012
Last updated
11/08/2012
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