Provider Demographics
NPI:1366449563
Name:FAZZINO, DOLORES LINDA (FNP)
Entity Type:Individual
Prefix:MS
First Name:DOLORES
Middle Name:LINDA
Last Name:FAZZINO
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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
Is Sole Proprietor?:No
Enumeration Date:2005-07-01
Last Update Date:2007-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP11272363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CANP0112720Medicaid
CAS94799Medicare UPIN
CANP11272Medicare ID - Type UnspecifiedNURSE PRACTITIONER