Provider Demographics
NPI:1134390206
Name:SCARMAZZO, NICHOLAS GARY
Entity type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:GARY
Last Name:SCARMAZZO
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 1:2552 TORREY PINES RD
Mailing Address - Street 2:
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92037-3432
Mailing Address - Country:US
Mailing Address - Phone:858-453-5810
Mailing Address - Fax:
Practice Address - Street 1:2552 TORREY PINES RD
Practice Address - Street 2:
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92037-3432
Practice Address - Country:US
Practice Address - Phone:858-453-5810
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-17
Last Update Date:2008-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOT 7752225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist