Healthcare Provider Details

I. General information

NPI: 1003012642
Provider Name (Legal Business Name): NARGES MAZLOOM D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/21/2007
Last Update Date: 07/08/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

103 MEMORIAL MEDICAL PKWY STE 125
DAYTONA BEACH FL
32117-5672
US

IV. Provider business mailing address

11945 SAN JOSE BLVD STE 300
JACKSONVILLE FL
32223-1627
US

V. Phone/Fax

Practice location:
  • Phone: 386-274-0250
  • Fax: 386-274-0269
Mailing address:
  • Phone: 904-396-1725
  • Fax: 904-396-4893

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YS0123X
TaxonomyFacial Plastic Surgery Physician
License NumberOS13202
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: