Provider Demographics
NPI:1710025333
Name:IGNACIO, LUIS FAUSTINO (MD)
Entity Type:Individual
Prefix:DR
First Name:LUIS
Middle Name:FAUSTINO
Last Name:IGNACIO
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1206 FAIRWAY DR
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23320-9400
Mailing Address - Country:US
Mailing Address - Phone:757-547-1638
Mailing Address - Fax:757-549-0663
Practice Address - Street 1:1500 E LITTLE CREEK RD
Practice Address - Street 2:205
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23518-4137
Practice Address - Country:US
Practice Address - Phone:757-587-4744
Practice Address - Fax:757-587-4947
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-03
Last Update Date:2014-03-13
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Provider Licenses
StateLicense IDTaxonomies
VA01010461362084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA71-6051-8Medicaid
VA71-6051-8Medicaid
B35386Medicare UPIN