Healthcare Provider Details

I. General information

NPI: 1235470501
Provider Name (Legal Business Name): MARCO LUIGI ZUCCONI MA, ATC, NASM-PES
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/11/2013
Last Update Date: 03/11/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4020 MURPHY CANYON RD
SAN DIEGO CA
92123-4407
US

IV. Provider business mailing address

4020 MURPHY CANYON RD
SAN DIEGO CA
92123-4407
US

V. Phone/Fax

Practice location:
  • Phone: 858-874-4506
  • Fax: 858-292-4690
Mailing address:
  • Phone: 858-874-4506
  • Fax: 858-292-4690

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: