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NPI Code Detail

MEDICARE: MR. JESSE J MAZZA A.T.,C.

MEDICARE: MR. JESSE J MAZZA A.T.,C.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1174400000XSpecialist

General Provider Information

NPI Number : 1417921339
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. JESSE J MAZZA A.T.,C.
Provider Business Mailing Address
First Line : 1277 ECHO RIDGE CT
Second Line :
City : SAN JOSE
State : CA
Zip : 95120-4717
Country : US
Telephone Number : 415-257-1353
Fax Number :
Provider Business Practice Location Address
First Line : 50 ACACIA AVE
Second Line :
City : SAN RAFAEL
State : CA
Zip : 94901-2230
Country : US
Telephone Number : 415-257-1353
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/15/2006
Last Update Date : 07/08/2007

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