Provider Demographics
NPI:1891724886
Name:FARO T. OWIESY, M.D., INC
Entity Type:Organization
Organization Name:FARO T. OWIESY, M.D., INC
Other - Org Name:CORONA DOCTORS MEDICAL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:FARO
Authorized Official - Middle Name:T
Authorized Official - Last Name:OWIESY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:951-371-9500
Mailing Address - Street 1:802 MAGNOLIA AVE
Mailing Address - Street 2:SUITE 106
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92879-3104
Mailing Address - Country:US
Mailing Address - Phone:951-371-9500
Mailing Address - Fax:951-371-9194
Practice Address - Street 1:802 MAGNOLIA AVE
Practice Address - Street 2:SUITE 106
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92879-3125
Practice Address - Country:US
Practice Address - Phone:951-371-9500
Practice Address - Fax:951-371-9194
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-02
Last Update Date:2013-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA87796207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAI 12198Medicare UPIN