Healthcare Provider Details

I. General information

NPI: 1760215701
Provider Name (Legal Business Name): MR. NICHOLAS JOHN POLLIZZI
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/23/2024
Last Update Date: 05/04/2026
Certification Date: 05/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4438 BUCKEYE WAY
ANTIOCH CA
94531-9334
US

IV. Provider business mailing address

233 J ST
DAVIS CA
95616-4218
US

V. Phone/Fax

Practice location:
  • Phone: 925-755-8499
  • Fax: 925-755-8495
Mailing address:
  • Phone: 916-250-9301
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code373H00000X
TaxonomyDay Training/Habilitation Specialist
License Number103K00000X
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: