MEDICARE: GABRIEL JOSEPH MAZUR

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
1	103K00000X	Behavior Analyst		FL

General Provider Information

NPI Number	:	1427800267
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GABRIEL JOSEPH MAZUR

Provider Business Mailing Address
First Line	:	2195 VIVIAN WAY S
Second Line	:
City	:	SAINT PETERSBURG
State	:	FL
Zip	:	33712-6062
Country	:	US
Telephone Number	:	941-724-6978
Fax Number	:

Provider Business Practice Location Address
First Line	:	2195 VIVIAN WAY S
Second Line	:
City	:	SAINT PETERSBURG
State	:	FL
Zip	:	33712-6062
Country	:	US
Telephone Number	:	941-724-6978
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/04/2024
Last Update Date	:	04/04/2024

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Directions to “ GABRIEL JOSEPH MAZUR ” Practice Location

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