Provider Demographics
NPI:1164862207
Name:SAZON, NICK GONZALES
Entity Type:Individual
Prefix:MR
First Name:NICK
Middle Name:GONZALES
Last Name:SAZON
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 1:3400 TARAWA RD
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92155-5176
Mailing Address - Country:US
Mailing Address - Phone:619-437-5540
Mailing Address - Fax:
Practice Address - Street 1:3400 TARAWA RD
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92155-5176
Practice Address - Country:US
Practice Address - Phone:619-437-5540
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-03
Last Update Date:2013-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman