# DR. DOREEN T FAZIO

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1831194398
- **Gender:** F
- **Credential:** M.D.

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207W00000X | Ophthalmology Physician | G041260 | CA | Yes |

## Other

- **Enumeration date:** 06/20/2005
- **Last updated:** 12/30/2008

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | GR0063310 | — | CA |
| 01 | — | W13323 | GROUP ID | CA |
| 01 | — | WG41260E | PPIN | CA |
| 01 | — | ZZZ91696Z | BLUE SHIELD | CA |