Provider Demographics
NPI:1609216688
Name:NITZEL, DALE (ATC)
Entity Type:Individual
Prefix:
First Name:DALE
Middle Name:
Last Name:NITZEL
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2466 CALLE AGUADULCE
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92139-2211
Mailing Address - Country:US
Mailing Address - Phone:619-885-0911
Mailing Address - Fax:
Practice Address - Street 1:H100 SANTA MARGARITA ROAD
Practice Address - Street 2:NAVAL HOSPITAL CAMP PENDELTON ATTENTION: CODE 00QM
Practice Address - City:CAMP PENDELTON
Practice Address - State:CA
Practice Address - Zip Code:92055-5191
Practice Address - Country:US
Practice Address - Phone:760-763-6611
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-05
Last Update Date:2013-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171000000XOther Service ProvidersMilitary Health Care Provider