Simone Genevieve Fauquet, PSS STUDENT

Primary specialty

Student in an Organized Health Care Education/Training ProgramTaxonomy code 390200000X

License

BL17-000035 Issued in CA

Practice address

621 E Grand Ave
Arroyo Grande, CA 93420-3241

Phone

(805) 202-3440

Fax

(805) 202-3441

NPI assigned

Sep 25, 2017

Last updated

Sep 25, 2017By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Ms. Simone G. Fauquet Professional name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Tikva Treatment LLC

  dba The Haven at Pismo

  • Substance Use Disorder Rehabilitation Clinic/Center
  • Arroyo Grande, CA
  • NPI 1831541986
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1506297600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1506297600000",
    "number": "1578072336",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "621 E GRAND AVE",
            "city": "ARROYO GRANDE",
            "state": "CA",
            "postal_code": "934203241",
            "telephone_number": "805-202-3440"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "621 E GRAND AVE",
            "city": "ARROYO GRANDE",
            "state": "CA",
            "postal_code": "934203241",
            "telephone_number": "805-202-3440",
            "fax_number": "805-202-3441"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FAUQUET",
        "first_name": "SIMONE",
        "middle_name": "GENEVIEVE",
        "name_prefix": "Miss",
        "credential": "PSS STUDENT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-09-25",
        "last_updated": "2017-09-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "CA",
            "license": "BL17-000035",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ADDICTION MEDICINE",
            "identifier": "1831541986",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "SIMONE",
            "last_name": "FAUQUET",
            "middle_name": "G.",
            "prefix": "MS.",
            "credential": "PSS STUDENT",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

• Excellence in Rehabilitation Medical Group Inc
• Exclusive Home Care Services
• Fair Oaks Pharmacy, Inc
• Family Care Network, Inc
• Family Care Network, Inc
• Jose Rosa Feliberti, MD
• Thomas Daniel Ferro, M.D.
• Taylor Fink, RD
• Firstsight Vision Services, Inc.
• Five Cities Counseling Center

• Student in an Organized Health Care Education/Training Program in Arroyo Grande, CA
• Providers in Arroyo Grande, CA by specialty
• Student in an Organized Health Care Education/Training Program in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 25, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.