Provider Demographics
NPI:1285843631
Name:MAZORRA, LORETTA (NP AND CNS)
Entity Type:Individual
Prefix:MS
First Name:LORETTA
Middle Name:
Last Name:MAZORRA
Suffix:
Gender:F
Credentials:NP AND CNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2112 CENTURY PARK LN
Mailing Address - Street 2:SUITE 217
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90067-3300
Mailing Address - Country:US
Mailing Address - Phone:310-772-0064
Mailing Address - Fax:310-772-0064
Practice Address - Street 1:2112 CENTURY PARK LN
Practice Address - Street 2:SUITE 217
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90067-3300
Practice Address - Country:US
Practice Address - Phone:310-772-0064
Practice Address - Fax:310-772-0064
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA1143834363L00000X, 364S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Not Answered364S00000XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse Specialist