Provider Demographics
NPI:1760215701
Name:POLLIZZI, NICHOLAS JOHN
Entity type:Individual
Prefix:MR
First Name:NICHOLAS
Middle Name:JOHN
Last Name:POLLIZZI
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 1:415 GAYLEY AVE APT 201
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90024-2039
Mailing Address - Country:US
Mailing Address - Phone:916-250-9301
Mailing Address - Fax:
Practice Address - Street 1:415 GAYLEY AVENUE
Practice Address - Street 2:APT 201
Practice Address - City:WESTWOOD
Practice Address - State:CA
Practice Address - Zip Code:90024
Practice Address - Country:US
Practice Address - Phone:916-250-9301
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-23
Last Update Date:2024-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA103K00000X103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst