Provider Demographics
NPI:1548402555
Name:FROILAN, FAUSTINO C (MD)
Entity Type:Individual
Prefix:
First Name:FAUSTINO
Middle Name:C
Last Name:FROILAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 EAST NINTH AVENUE
Mailing Address - Street 2:SIERRA VISTA HOSPITAL
Mailing Address - City:TRUTH OR CONSEQUENCES
Mailing Address - State:NM
Mailing Address - Zip Code:87901
Mailing Address - Country:US
Mailing Address - Phone:575-743-1230
Mailing Address - Fax:575-894-0835
Practice Address - Street 1:800 EAST NINTH AVENUE
Practice Address - Street 2:SIERRA VISTA HOSPITAL
Practice Address - City:TRUTH OR CONSEQUENCES
Practice Address - State:NM
Practice Address - Zip Code:87901
Practice Address - Country:US
Practice Address - Phone:575-743-1230
Practice Address - Fax:575-894-0835
Is Sole Proprietor?:No
Enumeration Date:2009-04-06
Last Update Date:2011-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMMD2009-0118207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine