Healthcare Provider Details

I. General information

NPI: 1063612661
Provider Name (Legal Business Name): CYNTHIA MARIE FIACCO N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2007
Last Update Date: 05/23/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5051 VERDUGO WAY SUITE 110
CAMARILLO CA
93012
US

IV. Provider business mailing address

5051 VERDUGO WAY SUITE 110
CAMARILLO CA
93012
US

V. Phone/Fax

Practice location:
  • Phone: 805-384-8071
  • Fax: 805-987-1927
Mailing address:
  • Phone: 805-384-8071
  • Fax: 805-987-1927

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberNP17104
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: