Provider Demographics
NPI:1164208260
Name:PREMPEH-COATES, FAUSTINA
Entity Type:Individual
Prefix:
First Name:FAUSTINA
Middle Name:
Last Name:PREMPEH-COATES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15827 W MONROE ST
Mailing Address - Street 2:
Mailing Address - City:GOODYEAR
Mailing Address - State:AZ
Mailing Address - Zip Code:85338-6896
Mailing Address - Country:US
Mailing Address - Phone:602-930-5974
Mailing Address - Fax:623-303-1526
Practice Address - Street 1:9548 W AGORA LN
Practice Address - Street 2:
Practice Address - City:TOLLESON
Practice Address - State:AZ
Practice Address - Zip Code:85353-4564
Practice Address - Country:US
Practice Address - Phone:602-930-5974
Practice Address - Fax:623-303-1526
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-05
Last Update Date:2023-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZDDH3872251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services