Healthcare Provider Details

I. General information

NPI: 1366449563
Provider Name (Legal Business Name): DOLORES LINDA FAZZINO FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/01/2005
Last Update Date: 06/21/2024
Certification Date: 06/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1622 PLEASANT PL
ENCINITAS CA
92024-1975
US

IV. Provider business mailing address

1622 PLEASANT PL
ENCINITAS CA
92024-1975
US

V. Phone/Fax

Practice location:
  • Phone: 760-579-2440
  • Fax: 760-632-8802
Mailing address:
  • Phone: 760-579-2440
  • Fax: 760-632-8802

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberNP11272
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: