Healthcare Provider Details

I. General information

NPI: 1710480140
Provider Name (Legal Business Name): JILL MAZZA, M.D., A PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/12/2018
Last Update Date: 03/12/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

191 S BUENA VISTA ST STE 320
BURBANK CA
91505-4556
US

IV. Provider business mailing address

191 S BUENA VISTA ST STE 320
BURBANK CA
91505-4556
US

V. Phone/Fax

Practice location:
  • Phone: 818-559-9727
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number
License Number StateCA

VIII. Authorized Official

Name: JILL MAZZA
Title or Position: PRESIDENT
Credential: MD
Phone: 818-559-9727