Provider Demographics
NPI:1477953370
Name:MAZU MEDICINE
Entity Type:Organization
Organization Name:MAZU MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRINCIPAL
Authorized Official - Prefix:
Authorized Official - First Name:FRISELDELYN
Authorized Official - Middle Name:
Authorized Official - Last Name:LOU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:415-295-6298
Mailing Address - Street 1:PO BOX 170115
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94117-0115
Mailing Address - Country:US
Mailing Address - Phone:415-295-6298
Mailing Address - Fax:
Practice Address - Street 1:1604 UNION ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94123-4507
Practice Address - Country:US
Practice Address - Phone:415-295-6298
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-27
Last Update Date:2014-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA15651305S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service