Provider Demographics
NPI:1598714446
Name:MAZZINI, JORGE CARLOS (MD)
Entity Type:Individual
Prefix:DR
First Name:JORGE
Middle Name:CARLOS
Last Name:MAZZINI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:765 PAREDES LINE RD
Mailing Address - Street 2:
Mailing Address - City:BROWNSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78521-2524
Mailing Address - Country:US
Mailing Address - Phone:956-548-0400
Mailing Address - Fax:956-548-0492
Practice Address - Street 1:765 PAREDES LINE RD
Practice Address - Street 2:
Practice Address - City:BROWNSVILLE
Practice Address - State:TX
Practice Address - Zip Code:78521-2524
Practice Address - Country:US
Practice Address - Phone:956-548-0400
Practice Address - Fax:956-548-0492
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-09
Last Update Date:2013-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ7079208000000X, 2080P0208X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No2080P0208XAllopathic & Osteopathic PhysiciansPediatricsPediatric Infectious Diseases
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX133201704Medicaid
TX133201706Medicaid
TX133201707Medicaid
TX742857385OtherTAX ID
TX116856OtherSUPERIOR/CHIP
TX133201706Medicaid