MEDICARE: DIANE LORETTA FATICA FNP/ANP-BC, DNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner	342352	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1578591608
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DIANE LORETTA FATICA FNP/ANP-BC, DNP

Provider Business Mailing Address
First Line	:	2496 BAUER RD
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92145-0001
Country	:	US
Telephone Number	:	858-577-6252
Fax Number	:	858-577-7754

Provider Business Practice Location Address
First Line	:	2496 BAUER RD
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92145-0001
Country	:	US
Telephone Number	:	858-577-6252
Fax Number	:	858-577-7754

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/29/2006
Last Update Date	:	12/20/2011

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