Provider Demographics
NPI:1801014808
Name:PIZZUTI, CARL A
Entity Type:Individual
Prefix:DR
First Name:CARL
Middle Name:A
Last Name:PIZZUTI
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 1:301 MARBLE LN
Mailing Address - Street 2:
Mailing Address - City:PALM SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:92264-8363
Mailing Address - Country:US
Mailing Address - Phone:213-304-3294
Mailing Address - Fax:
Practice Address - Street 1:69160 RAMON ROAD
Practice Address - Street 2:STE. #100
Practice Address - City:CATHEDRAL CITY
Practice Address - State:CA
Practice Address - Zip Code:92234-3343
Practice Address - Country:US
Practice Address - Phone:760-969-5469
Practice Address - Fax:760-770-0280
Is Sole Proprietor?:No
Enumeration Date:2007-04-23
Last Update Date:2011-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA21497122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAD21497Medicaid