Provider Demographics
NPI:1386991115
Name:FASSERO, KATHRYN BAZ (NP)
Entity type:Individual
Prefix:MRS
First Name:KATHRYN
Middle Name:BAZ
Last Name:FASSERO
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MS
Other - First Name:KATHRYN
Other - Middle Name:LYNN
Other - Last Name:BAZILAUSKAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:220 LIVORNA HEIGHTS RD
Mailing Address - Street 2:
Mailing Address - City:ALAMO
Mailing Address - State:CA
Mailing Address - Zip Code:94507-1325
Mailing Address - Country:US
Mailing Address - Phone:310-497-2925
Mailing Address - Fax:925-838-4545
Practice Address - Street 1:360 ROSE AVE
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:CA
Practice Address - Zip Code:94526-3320
Practice Address - Country:US
Practice Address - Phone:925-838-4363
Practice Address - Fax:925-838-4545
Is Sole Proprietor?:No
Enumeration Date:2012-08-10
Last Update Date:2017-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA21661363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health