Provider Demographics
NPI:1043309529
Name:PERRIZO, NATHAN ADAM (DO)
Entity Type:Individual
Prefix:DR
First Name:NATHAN
Middle Name:ADAM
Last Name:PERRIZO
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:477 N EL CAMINO REAL STE B301
Mailing Address - Street 2:
Mailing Address - City:ENCINITAS
Mailing Address - State:CA
Mailing Address - Zip Code:92024-1331
Mailing Address - Country:US
Mailing Address - Phone:760-753-1104
Mailing Address - Fax:760-943-6494
Practice Address - Street 1:3998 VISTA WAY STE 108
Practice Address - Street 2:
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92056-4515
Practice Address - Country:US
Practice Address - Phone:760-941-7336
Practice Address - Fax:760-943-6494
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2012-06-15
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CA20A10372208100000X, 208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine