Provider Demographics
NPI:1235350638
Name:CHENG, FAUSTO SO (RN, APRN)
Entity Type:Individual
Prefix:MR
First Name:FAUSTO
Middle Name:SO
Last Name:CHENG
Suffix:
Gender:M
Credentials:RN, APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 LOUISIANA CV
Mailing Address - Street 2:
Mailing Address - City:ODESSA
Mailing Address - State:TX
Mailing Address - Zip Code:79762-4793
Mailing Address - Country:US
Mailing Address - Phone:432-362-4703
Mailing Address - Fax:432-640-2428
Practice Address - Street 1:419 W 5TH ST
Practice Address - Street 2:
Practice Address - City:ODESSA
Practice Address - State:TX
Practice Address - Zip Code:79761-5026
Practice Address - Country:US
Practice Address - Phone:432-640-2128
Practice Address - Fax:432-640-2428
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX462957363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily