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NPI Code Detail

MEDICARE: WILLIAM HENRY MAZZARELLA JR. COUNSELOR

MEDICARE: WILLIAM HENRY MAZZARELLA JR. COUNSELOR
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
1163WA0400XAddiction (Substance Use Disorder) Registered Nurse530630CA

General Provider Information

NPI Number : 1770787111
Entity Type Code : Individual
Provider Name (Legal Business Name) : WILLIAM HENRY MAZZARELLA JR. COUNSELOR
Provider Business Mailing Address
First Line : 2120 COLUMBIA ST STE 8
Second Line :
City : SAN DIEGO
State : CA
Zip : 92101-1879
Country : US
Telephone Number : 619-380-0560
Fax Number :
Provider Business Practice Location Address
First Line : 2456 E ST
Second Line :
City : SAN DIEGO
State : CA
Zip : 92102-2024
Country : US
Telephone Number : 619-503-7680
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/11/2007
Last Update Date : 05/17/2026

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