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General NPI Number Information
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NPI Number | 1619614922
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Entity Type | Individual
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Provider Name | CAMERON MAZZA
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Gender | Male
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Dates
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Enumeration Date | 05/18/2022
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Last Update Date | 11/07/2023
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Provider Practice Location Address
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Address Line | 901 WILSHIRE BLVD FL 1
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City | SANTA MONICA
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State | CA
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Zip | 90401-1854
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Country | US
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Telephone | 310-829-8945
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Fax |
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Provider Business Mailing Address
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Address Line | 52 BAROLO
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City | RANCHO MIRAGE
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State | CA
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Zip | 92270-5650
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Country | US
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Telephone | 650-346-7440
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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 | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | RN306180
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 95024133
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License Number State | CA
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