Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RC0000X | Internist - Cardiovascular Disease | 7676143-1205 | UT |
Y | 207RC0000X | Internist - Cardiovascular Disease | C155200 | CA |
NPI | 1003017666 |
---|---|
Provider Name | Dr. Cory Michael Lee Nitzel |
First Address | Salt Lake City, UT 84141-3033 |
Second Address | Ventura, CA 93003-1651 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/05/2007 |
Last Update Date | 26/03/2020 |