Individual
DR. MICHAEL JOSEPH FAZIO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1525 RESPONSE RD, SACRAMENTO, CA 95815-4801
(916) 492-1828
(916) 492-1834
Mailing address
1525 RESPONSE RD, SACRAMENTO, CA 95815-4801
(916) 492-1828
(916) 492-1834
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
G059079
CA
207ND0101X
MOHS-Micrographic Surgery Physician
Primary
G059079
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
05D0615441
CLIA
CA
Enumeration date
06/24/2005
Last updated
03/26/2025
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