Healthcare Provider Details

I. General information

NPI: 1902453723
Provider Name (Legal Business Name): NICOLE V ZAPPELLI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/26/2019
Last Update Date: 08/26/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4990 WILLIAM AVE.
LA MESA CA
91942
US

IV. Provider business mailing address

4990 WILLIAMS AVE
LA MESA CA
91942-7409
US

V. Phone/Fax

Practice location:
  • Phone: 619-782-4001
  • Fax:
Mailing address:
  • Phone: 619-782-4001
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: