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Organization
PETER NICOLAZZO, M.D., INC
Active
Organization
PETER NICOLAZZO, M.D., INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PETER NICOLAZZO M.D. (DIRECT OWNER)
(818) 888-7815
Entity
Organization
Contact information
Practice address
24355 LYONS AVE, STE.# 120, SANTA CLARITA, CA 91321-2300
(661) 255-6644
Mailing address
PO BOX 7001, TARZANA, CA 91357-7001
(818) 888-7815
(818) 715-1722
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
G76738
CA
207LP2900X
Pain Medicine (Anesthesiology) Physician
G76738A
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00G767380
MEDI-CAL /EDS
CA
01
—
273481700
US DEPT OF LABOR
CA
01
—
G76738A
MEDICARE SO CAL.
CA
Enumeration date
08/16/2007
Last updated
08/16/2007
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