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General NPI Number Information
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NPI Number | 1396807798
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Entity Type | Organization
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Legal Business Name | DEL MAZO MEDICAL SERVICES
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Dates
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Enumeration Date | 12/14/2006
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Last Update Date | 11/19/2011
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Provider Practice Location Address
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Address Line | 550 PEACHTREE ST NE SUITE 1035
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City | ATLANTA
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State | GA
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Zip | 30308-2221
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Country | US
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Telephone | 404-577-1112
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Fax | 404-557-1543
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Provider Business Mailing Address
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Address Line | 550 PEACHTREE ST NE SUITE 1035
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City | ATLANTA
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State | GA
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Zip | 30308-2221
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Country | US
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Telephone | 404-577-1112
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Fax | 404-577-1543
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | ARLENE DEL MAZO
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Credential | R.N.
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Telephone | 404-880-4201
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RI0011X
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Taxonomy Name | Interventional Cardiology Physician
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License Number | 036741
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 207RR0500X
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Taxonomy Name | Rheumatology Physician
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License Number | 025728
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License Number State | GA
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Taxonomy #3
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number | 014238
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License Number State | GA
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