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General NPI Number Information
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NPI Number | 1104660554
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Entity Type | Individual
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Provider Name | KYLE MAZUROWSKI
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Gender | Male
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Dates
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Enumeration Date | 06/20/2024
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Last Update Date | 06/20/2024
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Provider Practice Location Address
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Address Line | 8850 E PIMA CENTER PKWY
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City | SCOTTSDALE
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State | AZ
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Zip | 85258-4619
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Country | US
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Telephone | 480-800-3900
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Fax |
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Provider Business Mailing Address
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Address Line | 14849 N KINGS WAY UNIT 223
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City | FOUNTAIN HILLS
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State | AZ
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Zip | 85268-2974
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Country | US
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Telephone | 480-387-9721
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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 | 376K00000X
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Taxonomy Name | Nurse's Aide
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License Number | 274375
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License Number State | AZ
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