Provider Demographics
NPI:1508936139
Name:MAZEL-GEE, LEAH (LAC)
Entity Type:Individual
Prefix:MS
First Name:LEAH
Middle Name:
Last Name:MAZEL-GEE
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:MS
Other - First Name:PATRICIA
Other - Middle Name:L
Other - Last Name:SHELDON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LAC
Mailing Address - Street 1:1442A WALNUT ST
Mailing Address - Street 2:BOX 430
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94709-1405
Mailing Address - Country:US
Mailing Address - Phone:510-548-5676
Mailing Address - Fax:510-486-1221
Practice Address - Street 1:2046 LINCOLN ST
Practice Address - Street 2:SUITE 4
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94709-2018
Practice Address - Country:US
Practice Address - Phone:510-548-5676
Practice Address - Fax:510-486-1221
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1497171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist