Provider Demographics
NPI:1780785246
Name:FAIN, MINDY JOY (MD)
Entity type:Individual
Prefix:
First Name:MINDY
Middle Name:JOY
Last Name:FAIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2215 EAST MIRAVAL TERCERO
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85718
Mailing Address - Country:US
Mailing Address - Phone:520-299-8514
Mailing Address - Fax:
Practice Address - Street 1:3601 SOUTH SIXTH AVENUE
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:95723
Practice Address - Country:US
Practice Address - Phone:520-629-1838
Practice Address - Fax:520-629-1758
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ15056207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine