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General NPI Number Information
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NPI Number | 1972321628
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Entity Type | Individual
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Provider Name | NICOLE MAZMANIAN FNP
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Gender | Female
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Dates
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Enumeration Date | 10/01/2024
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Last Update Date | 08/11/2025
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Provider Practice Location Address
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Address Line | 72780 COUNTRY CLUB DR STE 103
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City | RANCHO MIRAGE
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State | CA
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Zip | 92270-4150
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Country | US
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Telephone | 760-779-5511
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Fax |
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Provider Business Mailing Address
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Address Line | 20 VISTA MIRAGE WAY
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City | RANCHO MIRAGE
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State | CA
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Zip | 92270-1906
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Country | US
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Telephone | 760-413-0295
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 95032198
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License Number State | CA
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