Healthcare Provider Details

I. General information

NPI: 1629317433
Provider Name (Legal Business Name): MAZIN K YALDO MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/14/2013
Last Update Date: 05/27/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2810 CAMINO DEL RIO S SUITE 106
SAN DIEGO CA
92108-3818
US

IV. Provider business mailing address

31535 FORD RD
GARDEN CITY MI
48135-1821
US

V. Phone/Fax

Practice location:
  • Phone: 619-255-6584
  • Fax: 619-501-9054
Mailing address:
  • Phone: 313-278-4540
  • Fax: 313-278-4541

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberG70910
License Number StateCA

VIII. Authorized Official

Name: DR. MAZIN K YALDO
Title or Position: PRESIDENT/OWNER
Credential: MD
Phone: 313-278-4540