MEDICARE: LEELA MAZAREI

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	363A00000X	Physician Assistant

General Provider Information

NPI Number	:	1912726316
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LEELA MAZAREI

Provider Business Mailing Address
First Line	:	PO BOX 35380
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89133-5380
Country	:	US
Telephone Number	:	702-579-3203
Fax Number	:

Provider Business Practice Location Address
First Line	:	8239 ROCHESTER AVE
Second Line	:
City	:	RANCHO CUCAMONGA
State	:	CA
Zip	:	91730-0714
Country	:	US
Telephone Number	:	909-941-0266
Fax Number	:

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

Provider Enumeration Date	:	10/03/2024
Last Update Date	:	11/23/2025

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Directions to “ LEELA MAZAREI ” Practice Location

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