Provider Demographics
NPI:1609038710
Name:MAZAR, MICHAEL (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:MAZAR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:5767 W CENTURY BLVD
Mailing Address - Street 2:200
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90045-5632
Mailing Address - Country:US
Mailing Address - Phone:310-582-6220
Mailing Address - Fax:310-582-6222
Practice Address - Street 1:2020 SANTA MONICA BLVD
Practice Address - Street 2:SUITE 220
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90404-2023
Practice Address - Country:US
Practice Address - Phone:310-582-6220
Practice Address - Fax:310-582-6222
Is Sole Proprietor?:No
Enumeration Date:2008-06-30
Last Update Date:2010-03-29
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAA102139207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0A1021390Medicaid
CAAP331ZMedicare PIN