Individual
DR. MYLANIE C. FACELO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.O.
Contact information
Practice address
5555 E RIVER RD # 219, TUCSON, AZ 85750-1949
(520) 314-4275
Mailing address
3501 E SPEEDWAY BLVD STE 300, TUCSON, AZ 85716-3928
(520) 833-5171
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
0116028424
VA
207Q00000X
Family Medicine Physician
R73583
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
R73583
TRAINING PERMIT
AZ
Enumeration date
06/25/2012
Last updated
09/20/2018
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