Provider Demographics
NPI:1902939408
Name:MAZZONE, FRANK (MD)
Entity Type:Individual
Prefix:DR
First Name:FRANK
Middle Name:
Last Name:MAZZONE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:47 SANTA ROSA ST
Mailing Address - Street 2:
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93405-5816
Mailing Address - Country:US
Mailing Address - Phone:805-542-9596
Mailing Address - Fax:805-542-0845
Practice Address - Street 1:47 SANTA ROSA ST
Practice Address - Street 2:
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93405-5816
Practice Address - Country:US
Practice Address - Phone:805-542-9596
Practice Address - Fax:805-542-0845
Is Sole Proprietor?:No
Enumeration Date:2007-03-13
Last Update Date:2016-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA44092207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA770531398OtherTAX ID
CA770531398OtherTAX ID
CAWA44092CMedicare PIN
CAW14897Medicare ID - Type Unspecified