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General NPI Number Information
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NPI Number | 1578980751
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Entity Type | Individual
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Provider Name | MAZVITA ETHEL SIMOYI MD
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Gender | Female
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Dates
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Enumeration Date | 03/25/2014
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Last Update Date | 09/29/2021
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Provider Practice Location Address
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Address Line | 425 S 11TH ST
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City | LAKE WALES
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State | FL
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Zip | 33853-4239
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Country | US
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Telephone | 844-634-3627
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Fax | 863-676-3621
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Provider Business Mailing Address
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Address Line | 425 S 11TH ST
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City | LAKE WALES
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State | FL
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Zip | 33853-4239
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Country | US
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Telephone | 844-634-3627
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Fax | 863-676-3621
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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 | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | ME140906
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License Number State | FL
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