Healthcare Provider Details

I. General information

NPI: 1700049731
Provider Name (Legal Business Name): JILL MAZZA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/09/2008
Last Update Date: 09/22/2025
Certification Date: 09/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 S BUENA VISTA ST
BURBANK CA
91505-4809
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 818-847-6049
  • Fax: 818-847-4842
Mailing address:
  • Phone: 818-559-9727
  • Fax: 818-559-5514

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207YX0007X
TaxonomyPlastic Surgery within the Head & Neck (Otolaryngology) Physician
License NumberA113348
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License NumberA113348
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: