Provider Demographics
NPI:1578591608
Name:FATICA, DIANE LORETTA (FNP/ANP-BC, DNP)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:LORETTA
Last Name:FATICA
Suffix:
Gender:F
Credentials:FNP/ANP-BC, DNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2496 BAUER RD
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92145-0001
Mailing Address - Country:US
Mailing Address - Phone:858-577-6252
Mailing Address - Fax:858-577-7754
Practice Address - Street 1:2496 BAUER RD
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92145-0001
Practice Address - Country:US
Practice Address - Phone:858-577-6252
Practice Address - Fax:858-577-7754
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2011-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA342352363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
CARN8393Medicaid
CA4112180001Medicare NSC
CAP07618Medicare UPIN
CARN8393Medicaid