Healthcare Provider Details

I. General information

NPI: 1073738449
Provider Name (Legal Business Name): NICK DAN SPALLIERO SR. RASI
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/13/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

907 EAST LANCASTER BLVD
LANCASTER CA
93534
US

IV. Provider business mailing address

17725 COOLWATER AVE
PALMDALE CA
93591-3117
US

V. Phone/Fax

Practice location:
  • Phone: 661-726-2630
  • Fax:
Mailing address:
  • Phone: 661-264-2296
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: