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General NPI Number Information
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NPI Number | 1770787111
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Entity Type | Individual
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Provider Name | WILLIAM HENRY MAZZARELLA JR. COUNSELOR
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Gender | Male
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Dates
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Enumeration Date | 06/11/2007
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Last Update Date | 07/17/2025
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Provider Practice Location Address
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Address Line | 2456 E ST
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City | SAN DIEGO
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State | CA
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Zip | 92102-2024
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Country | US
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Telephone | 619-503-7680
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Fax |
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Provider Business Mailing Address
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Address Line | 2955 COMMERCIAL ST APT 2
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City | SAN DIEGO
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State | CA
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Zip | 92113-1364
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Country | US
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Telephone | 619-380-0560
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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 | 163WA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Registered Nurse
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License Number | 530630
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License Number State | CA
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