Provider Demographics
NPI:1104005271
Name:RAHELE MAZAREI, D.O., A.P.C.
Entity Type:Organization
Organization Name:RAHELE MAZAREI, D.O., A.P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RAHELE
Authorized Official - Middle Name:
Authorized Official - Last Name:MAZAREI
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:760-758-2820
Mailing Address - Street 1:3230 WARING CT
Mailing Address - Street 2:SUITE D
Mailing Address - City:OCEANSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92056-4509
Mailing Address - Country:US
Mailing Address - Phone:760-758-2820
Mailing Address - Fax:760-758-7057
Practice Address - Street 1:3230 WARING CT
Practice Address - Street 2:SUITE D
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92056-4509
Practice Address - Country:US
Practice Address - Phone:760-758-2820
Practice Address - Fax:760-758-7057
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-25
Last Update Date:2018-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A7358207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00AX73580Medicaid