Provider Demographics
NPI:1861134579
Name:MAZZOLA, JOSEPH DANTE (MD)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:DANTE
Last Name:MAZZOLA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:JOEY
Other - Middle Name:
Other - Last Name:MAZZOLA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:41 ANDREAS CIR
Mailing Address - Street 2:
Mailing Address - City:NOVATO
Mailing Address - State:CA
Mailing Address - Zip Code:94945-1230
Mailing Address - Country:US
Mailing Address - Phone:209-292-1884
Mailing Address - Fax:
Practice Address - Street 1:1975 4TH ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94143-2351
Practice Address - Country:US
Practice Address - Phone:206-543-6577
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-12
Last Update Date:2025-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA18611345792084P0800X
WA390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program