Provider Demographics
NPI:1518618529
Name:FAZZINO, CEARA MARIE
Entity Type:Individual
Prefix:
First Name:CEARA
Middle Name:MARIE
Last Name:FAZZINO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:732 CARNEGIE DR STE 100
Mailing Address - Street 2:
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92408-3589
Mailing Address - Country:US
Mailing Address - Phone:909-756-8887
Mailing Address - Fax:
Practice Address - Street 1:732 CARNEGIE DR STE 100
Practice Address - Street 2:
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92408-3589
Practice Address - Country:US
Practice Address - Phone:909-756-8887
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-11
Last Update Date:2022-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst