# PETER NICOLAZZO, M.D., INC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1588856215
- **Authorized official:** PETER NICOLAZZO M.D. (DIRECT OWNER)
- **Authorized official phone:** (818) 888-7815

## Contact information

- **Practice address:** 24355 LYONS AVE, STE.\# 120, SANTA CLARITA, CA 91321-2300
- **Practice address phone:** (661) 255-6644
- **Mailing address:** PO BOX 7001, TARZANA, CA 91357-7001
- **Mailing address phone:** (818) 888-7815
- **Mailing address fax:** (818) 715-1722

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207L00000X | Anesthesiology Physician | G76738 | CA | Yes |
| 207LP2900X | Pain Medicine (Anesthesiology) Physician | G76738A | CA | — |

## Other

- **Enumeration date:** 08/16/2007
- **Last updated:** 08/16/2007

## 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 |