MEDICARE: MS. DOLORES LINDA FAZZINO FNP

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	363LF0000X	Family Nurse Practitioner	NP11272	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	500022566	OTHER	CA	RAILROAD PROVIDER NUMBER
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1366449563
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. DOLORES LINDA FAZZINO FNP

Provider Business Mailing Address
First Line	:	1622 PLEASANT PL
Second Line	:
City	:	ENCINITAS
State	:	CA
Zip	:	92024-1975
Country	:	US
Telephone Number	:	760-579-2440
Fax Number	:	760-632-8802

Provider Business Practice Location Address
First Line	:	1622 PLEASANT PL
Second Line	:
City	:	ENCINITAS
State	:	CA
Zip	:	92024-1975
Country	:	US
Telephone Number	:	760-579-2440
Fax Number	:	760-632-8802

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

Provider Enumeration Date	:	07/01/2005
Last Update Date	:	06/21/2024

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