Provider Demographics
NPI:1871300897
Name:FAAIFO, LEGALO S
Entity type:Individual
Prefix:
First Name:LEGALO
Middle Name:S
Last Name:FAAIFO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26029 W CROWN KING RD
Mailing Address - Street 2:
Mailing Address - City:BUCKEYE
Mailing Address - State:AZ
Mailing Address - Zip Code:85326-1615
Mailing Address - Country:US
Mailing Address - Phone:907-891-6079
Mailing Address - Fax:
Practice Address - Street 1:26029 W CROWN KING RD
Practice Address - Street 2:
Practice Address - City:BUCKEYE
Practice Address - State:AZ
Practice Address - Zip Code:85326-1615
Practice Address - Country:US
Practice Address - Phone:907-891-6079
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-12
Last Update Date:2024-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ103K00000X, 376G00000X
172A00000X, 372600000X, 376J00000X, 374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No172A00000XOther Service ProvidersDriver
No372600000XNursing Service Related ProvidersAdult Companion
No376G00000XNursing Service Related ProvidersNursing Home Administrator
No376J00000XNursing Service Related ProvidersHomemaker