Provider Demographics
NPI:1275738288
Name:GIZZO, DANIEL PATRICK JR (PHD)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:PATRICK
Last Name:GIZZO
Suffix:JR
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 22165
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92192-2165
Mailing Address - Country:US
Mailing Address - Phone:619-590-5189
Mailing Address - Fax:619-590-5155
Practice Address - Street 1:1630 E MAIN ST
Practice Address - Street 2:3RD FLOOR
Practice Address - City:EL CAJON
Practice Address - State:CA
Practice Address - Zip Code:92021-5204
Practice Address - Country:US
Practice Address - Phone:619-590-5189
Practice Address - Fax:619-590-5155
Is Sole Proprietor?:No
Enumeration Date:2007-06-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY18926103TC0700X
NY015345103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical