Provider Demographics
NPI:1588009625
Name:MAZARIN, DANA WRAY (HAD)
Entity Type:Individual
Prefix:MRS
First Name:DANA
Middle Name:WRAY
Last Name:MAZARIN
Suffix:
Gender:F
Credentials:HAD
Other - Prefix:MISS
Other - First Name:DANA
Other - Middle Name:WRAY
Other - Last Name:KOSINSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5912 BOLSA AVE
Mailing Address - Street 2:STE 201
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92649-1146
Mailing Address - Country:US
Mailing Address - Phone:714-898-5732
Mailing Address - Fax:714-901-4058
Practice Address - Street 1:16030 VENTURA BLVD
Practice Address - Street 2:STE. 610
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91436-2731
Practice Address - Country:US
Practice Address - Phone:818-789-0463
Practice Address - Fax:818-789-0732
Is Sole Proprietor?:No
Enumeration Date:2013-05-02
Last Update Date:2014-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA7804237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist