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General NPI Number Information
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NPI Number | 1003474818
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Entity Type | Individual
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Provider Name | DIANE MARIE MAZZONI MS, PPS
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Gender | Female
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Dates
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Enumeration Date | 06/05/2019
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Last Update Date | 06/05/2019
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Provider Practice Location Address
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Address Line | 37479 AVENUE 12
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City | MADERA
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State | CA
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Zip | 93636-8726
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Country | US
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Telephone | 559-645-3572
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Fax |
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Provider Business Mailing Address
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Address Line | 17549 ROAD 36 1/2
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City | MADERA
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State | CA
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Zip | 93636-9207
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Country | US
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Telephone | 559-363-2583
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TS0200X
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Taxonomy Name | School Psychologist
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License Number | 2326
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License Number State | CA
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