Provider Demographics
NPI:1093853939
Name:NUZZO, PATRICK (DN)
Entity Type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:
Last Name:NUZZO
Suffix:
Gender:M
Credentials:DN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2006 BOTULPH RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87505
Mailing Address - Country:US
Mailing Address - Phone:505-424-8990
Mailing Address - Fax:505-424-6377
Practice Address - Street 1:3600 CERRILLOS RD
Practice Address - Street 2:SUITE 407
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87507-2612
Practice Address - Country:US
Practice Address - Phone:505-424-8990
Practice Address - Fax:505-424-6377
Is Sole Proprietor?:No
Enumeration Date:2007-02-02
Last Update Date:2018-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL181000111172P00000X
IL181.000111174400000X
NM0001174400000X, 172P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172P00000XOther Service ProvidersNaprapath
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL36-3979330OtherEIN
NM83-0429485OtherEIN