Healthcare Provider Details

I. General information

NPI: 1215352588
Provider Name (Legal Business Name): ERICA MAZZA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/24/2014
Last Update Date: 02/24/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6306 N 7TH ST
PHOENIX AZ
85014-1549
US

IV. Provider business mailing address

6306 N 7TH ST
PHOENIX AZ
85014-1549
US

V. Phone/Fax

Practice location:
  • Phone: 602-279-5801
  • Fax: 602-279-0033
Mailing address:
  • Phone: 602-279-5801
  • Fax: 602-279-0033

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: