Healthcare Provider Details

I. General information

NPI: 1821854910
Provider Name (Legal Business Name): STEVEN VINCENT ZIZZO MD MPH CCFP DABOM OH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/26/2024
Last Update Date: 02/26/2024
Certification Date: 01/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

122 15TH ST UNIT 2149
DEL MAR CA
92014-8065
US

IV. Provider business mailing address

122 15TH ST UNIT 2149
DEL MAR CA
92014-8065
US

V. Phone/Fax

Practice location:
  • Phone: 904-907-9011
  • Fax:
Mailing address:
  • Phone: 904-907-9011
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberC162411
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: