Provider Demographics
NPI:1396750279
Name:ZIZZO, PAOLO VINCENT (DO)
Entity type:Individual
Prefix:DR
First Name:PAOLO
Middle Name:VINCENT
Last Name:ZIZZO
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5055 AVENIDA ENCINAS
Mailing Address - Street 2:#100
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92008-4375
Mailing Address - Country:US
Mailing Address - Phone:760-448-4412
Mailing Address - Fax:760-918-9006
Practice Address - Street 1:5055 AVENIDA ENCINAS
Practice Address - Street 2:#100
Practice Address - City:CARLSBAD
Practice Address - State:CA
Practice Address - Zip Code:92008-4375
Practice Address - Country:US
Practice Address - Phone:760-448-4412
Practice Address - Fax:760-918-9006
Is Sole Proprietor?:No
Enumeration Date:2006-07-30
Last Update Date:2017-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A6835207R00000X, 207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
W20A6835DMedicare ID - Type Unspecified
G75185Medicare UPIN