Provider Demographics
NPI:1902902513
Name:FACIO, GILBERT JERRY (CSA)
Entity Type:Individual
Prefix:MR
First Name:GILBERT
Middle Name:JERRY
Last Name:FACIO
Suffix:
Gender:M
Credentials:CSA
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:313 E ROGER RD
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85705-2829
Mailing Address - Country:US
Mailing Address - Phone:520-887-5251
Mailing Address - Fax:520-887-1421
Practice Address - Street 1:2424 N WYATT DR
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85712-6115
Practice Address - Country:US
Practice Address - Phone:520-784-6200
Practice Address - Fax:520-784-6167
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZS0410XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Technologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZD31S3AOtherARIZ.FOUNDATION MED. CAR