Provider Demographics
NPI:1205131513
Name:JOHN R FAULKNER MEDICAL DOCTOR PC INC
Entity type:Organization
Organization Name:JOHN R FAULKNER MEDICAL DOCTOR PC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLER/OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CYNDI
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:GONZALEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:760-773-0572
Mailing Address - Street 1:72780 COUNTRY CLUB DR # C302
Mailing Address - Street 2:
Mailing Address - City:RANCHO MIRAGE
Mailing Address - State:CA
Mailing Address - Zip Code:92270-4126
Mailing Address - Country:US
Mailing Address - Phone:760-773-0572
Mailing Address - Fax:
Practice Address - Street 1:72780 COUNTRY CLUB DR # C302
Practice Address - Street 2:
Practice Address - City:RANCHO MIRAGE
Practice Address - State:CA
Practice Address - Zip Code:92270-4126
Practice Address - Country:US
Practice Address - Phone:760-773-0572
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-18
Last Update Date:2011-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA70567174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty