Provider Demographics
NPI:1700058476
Name:FAUSTINO, MARIVIC ABARQUEZ (PT)
Entity Type:Individual
Prefix:
First Name:MARIVIC
Middle Name:ABARQUEZ
Last Name:FAUSTINO
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17260 BEAR VALLEY ROAD
Mailing Address - Street 2:SUITE 105
Mailing Address - City:VICTORVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:92395-7778
Mailing Address - Country:US
Mailing Address - Phone:760-245-8828
Mailing Address - Fax:760-245-1968
Practice Address - Street 1:17260 BEAR VALLEY ROAD
Practice Address - Street 2:SUITE 105
Practice Address - City:VICTORVILLE
Practice Address - State:CA
Practice Address - Zip Code:92395-7778
Practice Address - Country:US
Practice Address - Phone:760-245-8828
Practice Address - Fax:760-245-1968
Is Sole Proprietor?:No
Enumeration Date:2008-04-02
Last Update Date:2008-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT27944225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist