Healthcare Provider Details

I. General information

NPI: 1831143452
Provider Name (Legal Business Name): DAVID SILVIO MAZZA D.P.M.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/19/2006
Last Update Date: 07/14/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

276 CHURCH AVE SUITE A
CHULA VISTA CA
91910-2729
US

IV. Provider business mailing address

276 CHURCH AVE SUITE A
CHULA VISTA CA
91910-2729
US

V. Phone/Fax

Practice location:
  • Phone: 619-427-0311
  • Fax: 619-427-0327
Mailing address:
  • Phone: 619-427-0311
  • Fax: 619-427-0327

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License NumberE2473
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: