Healthcare Provider Details

I. General information

NPI: 1255524427
Provider Name (Legal Business Name): MAZEN HASHISHO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2007
Last Update Date: 09/29/2026
Certification Date: 09/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3275 APTOS RANCHO RD STE 1A
APTOS CA
95003-3971
US

IV. Provider business mailing address

3275 APTOS RANCHO RD STE 1A
APTOS CA
95003-3971
US

V. Phone/Fax

Practice location:
  • Phone: 831-318-0010
  • Fax: 831-318-0407
Mailing address:
  • Phone: 631-662-2130
  • Fax: 831-318-0407

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License NumberMD441265
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number002845
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License NumberA94329
License Number StateCA
# 4
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License NumberA94329
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: