Provider Demographics
NPI:1316044373
Name:MAZIN, JEFFREY BYRON (MD,FACS,INC)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:BYRON
Last Name:MAZIN
Suffix:
Gender:M
Credentials:MD,FACS,INC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3737 MORAGA AVE STE B412
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92117-5363
Mailing Address - Country:US
Mailing Address - Phone:858-272-9996
Mailing Address - Fax:858-272-9959
Practice Address - Street 1:3737 MORAGA AVE
Practice Address - Street 2:STEB412
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92117-5404
Practice Address - Country:US
Practice Address - Phone:858-272-9996
Practice Address - Fax:858-272-9959
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG41431208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G414310Medicaid
CAB56960Medicare UPIN
CAG41431Medicare ID - Type Unspecified