Healthcare Provider Details

I. General information

NPI: 1093853939
Provider Name (Legal Business Name): PATRICK NUZZO DN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/02/2007
Last Update Date: 01/25/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3600 CERRILLOS RD SUITE 407
SANTA FE NM
87507-2612
US

IV. Provider business mailing address

2006 BOTULPH RD SUITE A
SANTA FE NM
87505
US

V. Phone/Fax

Practice location:
  • Phone: 505-424-8990
  • Fax: 505-424-6377
Mailing address:
  • Phone: 505-424-8990
  • Fax: 505-424-6377

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code172P00000X
TaxonomyNaprapath
License Number181000111
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number181.000111
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number0001
License Number StateNM
# 4
Primary TaxonomyY
Taxonomy Code172P00000X
TaxonomyNaprapath
License Number0001
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: