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General NPI Number Information
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NPI Number | 1912751231
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Entity Type | Organization
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Legal Business Name | MAZZY DEVELOPMENT CENTER
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Dates
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Enumeration Date | 04/15/2024
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Last Update Date | 03/01/2025
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Provider Practice Location Address
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Address Line | 23792 ROCKFIELD BLVD STE 230
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City | LAKE FOREST
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State | CA
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Zip | 92630-2872
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Country | US
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Telephone | 949-322-1202
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Fax |
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Provider Business Mailing Address
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Address Line | 23791 ROCKFILED #230
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City | LAKE FOREST
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State | CA
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Zip | 92630
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Country | US
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Telephone | 949-322-1202
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Fax |
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Authorized Official
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Title or Position | OFFICER
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Name | MRS. METRA AZAR-SALEM
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Credential | PSYD
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Telephone | 949-322-1202
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 2084P0802X
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Taxonomy Name | Addiction Psychiatry Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 2084P0804X
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Taxonomy Name | Child & Adolescent Psychiatry Physician
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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