Provider Demographics
NPI:1477552636
Name:FAULK, MARK S (AUD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:S
Last Name:FAULK
Suffix:
Gender:M
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3400 LOMA VISTA RD
Mailing Address - Street 2:SUITE 7
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93003-3033
Mailing Address - Country:US
Mailing Address - Phone:805-654-1566
Mailing Address - Fax:805-654-1262
Practice Address - Street 1:3400 LOMA VISTA RD
Practice Address - Street 2:SUITE 7
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93003-3033
Practice Address - Country:US
Practice Address - Phone:805-654-1566
Practice Address - Fax:805-654-1262
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-19
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAU1856237600000X
CAHA3812237600000X
AZDA0083237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAU0018560Medicaid
CAAU0018560Medicaid