Provider Demographics
NPI:1245413418
Name:MAZU, ANTONIO E
Entity Type:Individual
Prefix:
First Name:ANTONIO
Middle Name:E
Last Name:MAZU
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10925 BRIAR FOREST DR
Mailing Address - Street 2:# 2052
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77042-2255
Mailing Address - Country:US
Mailing Address - Phone:832-242-2614
Mailing Address - Fax:
Practice Address - Street 1:10925 BRIAR FOREST DR
Practice Address - Street 2:# 2052
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77042-2255
Practice Address - Country:US
Practice Address - Phone:832-242-2614
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-11
Last Update Date:2007-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXMT101297225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist