Basic Information
| Provider Information | |||||||||
| NPI: | 1154312403 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FAYNBOYM | ||||||||
| FirstName: | NATALYA | ||||||||
| MiddleName: | B | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 13640 N PLAZA DEL RIO BLVD | ||||||||
| Address2: | |||||||||
| City: | PEORIA | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 853814846 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6238763800 | ||||||||
| FaxNumber: | 6238766965 | ||||||||
| Practice Location | |||||||||
| Address1: | 9165 W THUNDERBIRD RD | ||||||||
| Address2: | STE 100 | ||||||||
| City: | PEORIA | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 853814847 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6235236560 | ||||||||
| FaxNumber: | 6235236581 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/03/2005 | ||||||||
| LastUpdateDate: | 04/07/2010 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208100000X | 34352 | AZ | Y | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | 208100000X | 2007-00545 | NC | N | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation |
ID Information
| ID | Type | State | Issuer | Description | 5907194 | 05 | NC | MEDICAID | Q45007 | 05 | SC | MEDICAID | 1154312403 | 05 | VA | MEDICAID | 968505 | 05 | AZ | MEDICAID | 3810009395 | 05 | WV | MEDICAID |