Healthcare Provider Details

I. General information

NPI: 1861268534
Provider Name (Legal Business Name): CARISSA CUZZONI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/04/2023
Last Update Date: 12/04/2023
Certification Date: 12/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2716 W 111TH LOOP
WESTMINSTER CO
80234-3141
US

IV. Provider business mailing address

8160 MANITOBA ST APT 101
PLAYA DEL REY CA
90293-8639
US

V. Phone/Fax

Practice location:
  • Phone: 805-452-6669
  • Fax:
Mailing address:
  • Phone: 805-452-6669
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number1680743
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: