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Individual
DR. DOREEN T FAZIO
Active
Individual
DR. DOREEN T FAZIO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
G041260
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GR0063310
—
CA
01
—
W13323
GROUP ID
CA
01
—
WG41260E
PPIN
CA
01
—
ZZZ91696Z
BLUE SHIELD
CA
Enumeration date
06/20/2005
Last updated
12/30/2008
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