Healthcare Provider Details

I. General information

NPI: 1396750279
Provider Name (Legal Business Name): PAOLO VINCENT ZIZZO D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/30/2006
Last Update Date: 09/20/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5055 AVENIDA ENCINAS #100
CARLSBAD CA
92008-4375
US

IV. Provider business mailing address

5055 AVENIDA ENCINAS #100
CARLSBAD CA
92008-4375
US

V. Phone/Fax

Practice location:
  • Phone: 760-448-4412
  • Fax: 760-918-9006
Mailing address:
  • Phone: 760-448-4412
  • Fax: 760-918-9006

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number20A6835
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number20A6835
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: