Individual
ERICA BERNADETTE FAZZINI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
11782 SW BARNES RD STE 300, PORTLAND, OR 97225-5933
(503) 906-4302
(503) 906-6613
Mailing address
2780 E BARNETT RD STE 200, MEDFORD, OR 97504-8674
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
196871
OR
363AS0400X
Surgical Physician Assistant
Primary
PA196871
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PA196871
PA LICENSE NUMBER
OR
Enumeration date
12/02/2019
Last updated
05/23/2022
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