Provider Demographics
NPI:1720019243
Name:FAUST, IRENE B (MD)
Entity Type:Individual
Prefix:PROF
First Name:IRENE
Middle Name:B
Last Name:FAUST
Suffix:
Gender:F
Credentials:MD
Other - Prefix:PROF
Other - First Name:IRENE
Other - Middle Name:B
Other - Last Name:FAUST
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:7345 MEDICAL CENTER DRIVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:WEST HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91307-1953
Mailing Address - Country:US
Mailing Address - Phone:818-888-3416
Mailing Address - Fax:818-888-1251
Practice Address - Street 1:7345 MEDICAL CENTER DRIVE
Practice Address - Street 2:SUITE 200
Practice Address - City:WEST HILLS
Practice Address - State:CA
Practice Address - Zip Code:91307-1953
Practice Address - Country:US
Practice Address - Phone:818-888-3416
Practice Address - Fax:818-888-1251
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-05
Last Update Date:2010-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG43186174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG43186Medicare ID - Type UnspecifiedMEDICARE
CAA49263Medicare UPIN