Healthcare Provider Details

I. General information

NPI: 1710881354
Provider Name (Legal Business Name): NICHOLAS DITTY
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/06/2026
Last Update Date: 10/06/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2122 S EL CAMINO REAL STE 102
OCEANSIDE CA
92054-6209
US

IV. Provider business mailing address

2122 S EL CAMINO REAL STE 102
OCEANSIDE CA
92054-6209
US

V. Phone/Fax

Practice location:
  • Phone: 760-290-8170
  • Fax:
Mailing address:
  • Phone: 760-290-8170
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License NumberMPSS-VGIWSD
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: