Provider Demographics
NPI:1083823173
Name:NICK C. LUIZZI, DDS, A PROFESSIONAL CORPORTION
Entity Type:Organization
Organization Name:NICK C. LUIZZI, DDS, A PROFESSIONAL CORPORTION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NICK
Authorized Official - Middle Name:C
Authorized Official - Last Name:LUIZZI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:805-525-5505
Mailing Address - Street 1:803 YALE ST
Mailing Address - Street 2:
Mailing Address - City:SANTA PAULA
Mailing Address - State:CA
Mailing Address - Zip Code:93060-2722
Mailing Address - Country:US
Mailing Address - Phone:805-525-5505
Mailing Address - Fax:805-525-9515
Practice Address - Street 1:803 YALE ST
Practice Address - Street 2:
Practice Address - City:SANTA PAULA
Practice Address - State:CA
Practice Address - Zip Code:93060-2722
Practice Address - Country:US
Practice Address - Phone:805-525-5505
Practice Address - Fax:805-525-9515
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA24824261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental