Provider Demographics
NPI:1043924855
Name:FAUSTO, TALISA ELAINE
Entity Type:Individual
Prefix:
First Name:TALISA
Middle Name:ELAINE
Last Name:FAUSTO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:TALISA
Other - Middle Name:ELAINE
Other - Last Name:ALMODOVAR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:18506 GREENING ST
Mailing Address - Street 2:
Mailing Address - City:ADELANTO
Mailing Address - State:CA
Mailing Address - Zip Code:92301-1544
Mailing Address - Country:US
Mailing Address - Phone:909-258-6730
Mailing Address - Fax:
Practice Address - Street 1:18506 GREENING ST
Practice Address - Street 2:
Practice Address - City:ADELANTO
Practice Address - State:CA
Practice Address - Zip Code:92301-1544
Practice Address - Country:US
Practice Address - Phone:909-258-6730
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-06
Last Update Date:2023-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula