Provider Demographics
NPI:1356787055
Name:FACIO, VIRGINIA PEARL (PT, CRTT, AS)
Entity type:Individual
Prefix:MRS
First Name:VIRGINIA
Middle Name:PEARL
Last Name:FACIO
Suffix:
Gender:F
Credentials:PT, CRTT, AS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220 N BALMAYNE ST
Mailing Address - Street 2:
Mailing Address - City:PORTERVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:93257-2607
Mailing Address - Country:US
Mailing Address - Phone:559-784-6655
Mailing Address - Fax:559-791-0805
Practice Address - Street 1:220 N BALMAYNE ST
Practice Address - Street 2:
Practice Address - City:PORTERVILLE
Practice Address - State:CA
Practice Address - Zip Code:93257-2607
Practice Address - Country:US
Practice Address - Phone:559-784-6655
Practice Address - Fax:559-791-0805
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-21
Last Update Date:2013-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA9389376J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker