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General NPI Number Information
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NPI Number | 1386825750
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Entity Type | Organization
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Legal Business Name | LAURENCE J. MAZZOTTA MD PC
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Dates
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Enumeration Date | 11/14/2007
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Last Update Date | 10/06/2010
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Provider Practice Location Address
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Address Line | 480 REDWOOD ST SUITE 14
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City | VALLEJO
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State | CA
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Zip | 94590-2958
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Country | US
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Telephone | 707-648-3327
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Fax | 707-648-3902
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Provider Business Mailing Address
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Address Line | 480 REDWOOD ST SUITE 14
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City | VALLEJO
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State | CA
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Zip | 94590-2958
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Country | US
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Telephone | 707-648-3327
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Fax | 707-648-3902
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Authorized Official
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Title or Position | SOLE PROPRIETOR
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Name | LAURENCE J MAZZOTTA
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Credential | MD
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Telephone | 707-648-3327
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number | G28907
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License Number State | CA
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