Healthcare Provider Details

I. General information

NPI: 1609216688
Provider Name (Legal Business Name): DALE NITZEL ATC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/05/2013
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34800 BOB WILSON DR
SAN DIEGO CA
92134-1098
US

IV. Provider business mailing address

2466 CALLE AGUADULCE
SAN DIEGO CA
92139-2211
US

V. Phone/Fax

Practice location:
  • Phone: 619-556-8096
  • Fax:
Mailing address:
  • Phone: 619-885-0911
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: