Provider Demographics
NPI:1104045350
Name:FAISCA, HEIDI ESTHER (OTL)
Entity Type:Individual
Prefix:
First Name:HEIDI
Middle Name:ESTHER
Last Name:FAISCA
Suffix:
Gender:F
Credentials:OTL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1799
Mailing Address - Street 2:
Mailing Address - City:TRUJILLO ALTO
Mailing Address - State:PR
Mailing Address - Zip Code:00977-1799
Mailing Address - Country:US
Mailing Address - Phone:787-502-3375
Mailing Address - Fax:787-755-3285
Practice Address - Street 1:D32 CARR 845
Practice Address - Street 2:FAIR VIEW
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00926-8146
Practice Address - Country:US
Practice Address - Phone:787-502-3375
Practice Address - Fax:787-755-3285
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR00667174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist