Provider Demographics
NPI:1902920945
Name:PIZITZ, TODD DAVID (PHD)
Entity type:Individual
Prefix:DR
First Name:TODD
Middle Name:DAVID
Last Name:PIZITZ
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:410 S MELROSE DR STE 202
Mailing Address - Street 2:
Mailing Address - City:VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:92081-6623
Mailing Address - Country:US
Mailing Address - Phone:760-806-4330
Mailing Address - Fax:760-806-4340
Practice Address - Street 1:410 S MELROSE DR STE 202
Practice Address - Street 2:
Practice Address - City:VISTA
Practice Address - State:CA
Practice Address - Zip Code:92081-6623
Practice Address - Country:US
Practice Address - Phone:760-806-4330
Practice Address - Fax:760-806-4340
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY18477103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACP18477Medicare ID - Type UnspecifiedPSYCHOLOGIST