Provider Demographics
NPI:1326315508
Name:MAZZA, BIANCA ROCIO (LPN)
Entity Type:Individual
Prefix:MISS
First Name:BIANCA
Middle Name:ROCIO
Last Name:MAZZA
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 770913
Mailing Address - Street 2:
Mailing Address - City:WOODSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11377-0913
Mailing Address - Country:US
Mailing Address - Phone:917-500-0870
Mailing Address - Fax:
Practice Address - Street 1:2410 23RD ST
Practice Address - Street 2:
Practice Address - City:ASTORIA
Practice Address - State:NY
Practice Address - Zip Code:11102-2836
Practice Address - Country:US
Practice Address - Phone:917-500-0870
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-16
Last Update Date:2011-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY297338164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse