Provider Demographics
NPI:1043392475
Name:NITSOS, LOUIS
Entity Type:Individual
Prefix:
First Name:LOUIS
Middle Name:
Last Name:NITSOS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 RODEO DR
Mailing Address - Street 2:UPMC EAST
Mailing Address - City:ARROYO GRANDE
Mailing Address - State:CA
Mailing Address - Zip Code:93420-2670
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:105 RODEO DR
Practice Address - Street 2:UPMC EAST
Practice Address - City:ARROYO GRANDE
Practice Address - State:CA
Practice Address - Zip Code:93420-2670
Practice Address - Country:US
Practice Address - Phone:404-901-4305
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2021-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD447904207L00000X
CAG75023207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAP00766179Medicare PIN
CAAT014YMedicare PIN
CAG47612Medicare UPIN
CAAT014VMedicare PIN
CAAT014WMedicare PIN
CAAT014ZMedicare PIN
CA00G750231Medicare PIN
CAAT014XMedicare PIN