Provider Demographics
NPI:1730961822
Name:KING, FAUSTINO RAMON
Entity type:Individual
Prefix:
First Name:FAUSTINO
Middle Name:RAMON
Last Name:KING
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:83456 IXTAPA AVE
Mailing Address - Street 2:
Mailing Address - City:COACHELLA
Mailing Address - State:CA
Mailing Address - Zip Code:92236-6395
Mailing Address - Country:US
Mailing Address - Phone:760-409-0674
Mailing Address - Fax:
Practice Address - Street 1:83456 IXTAPA AVE
Practice Address - Street 2:
Practice Address - City:COACHELLA
Practice Address - State:CA
Practice Address - Zip Code:92236-6395
Practice Address - Country:US
Practice Address - Phone:760-409-0674
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-16
Last Update Date:2023-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA36171225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist