Healthcare Provider Details

I. General information

NPI: 1609009034
Provider Name (Legal Business Name): DOLORES L. FAZZINO, RN, A PROFESSIONAL NURSING CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/02/2009
Last Update Date: 09/02/2009
Certification Date:
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 NumberNP 11272
License Number StateCA

VIII. Authorized Official

Name: DR. DOLORES LINDA FAZZINO
Title or Position: PRESIDENT
Credential: DNP, RN, FNP-BC
Phone: 760-579-2440