Provider Demographics
NPI:1609009034
Name:DOLORES L. FAZZINO, RN, A PROFESSIONAL NURSING CORPORATION
Entity type:Organization
Organization Name:DOLORES L. FAZZINO, RN, A PROFESSIONAL NURSING CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DOLORES
Authorized Official - Middle Name:LINDA
Authorized Official - Last Name:FAZZINO
Authorized Official - Suffix:
Authorized Official - Credentials:DNP, RN, FNP-BC
Authorized Official - Phone:760-579-2440
Mailing Address - Street 1:1622 PLEASANT PL
Mailing Address - Street 2:
Mailing Address - City:ENCINITAS
Mailing Address - State:CA
Mailing Address - Zip Code:92024-1975
Mailing Address - Country:US
Mailing Address - Phone:760-579-2440
Mailing Address - Fax:760-632-8802
Practice Address - Street 1:1622 PLEASANT PL
Practice Address - Street 2:
Practice Address - City:ENCINITAS
Practice Address - State:CA
Practice Address - Zip Code:92024-1975
Practice Address - Country:US
Practice Address - Phone:760-579-2440
Practice Address - Fax:760-632-8802
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-02
Last Update Date:2009-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP 11272363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty