Provider Demographics
NPI:1619272317
Name:MAZE, MERVYN (MB, CHB)
Entity Type:Individual
Prefix:DR
First Name:MERVYN
Middle Name:
Last Name:MAZE
Suffix:
Gender:M
Credentials:MB, CHB
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:521 PARNASSUS AVE
Mailing Address - Street 2:C455
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94143-0648
Mailing Address - Country:US
Mailing Address - Phone:415-476-9035
Mailing Address - Fax:415-514-1532
Practice Address - Street 1:521 PARNASSUS AVE
Practice Address - Street 2:C455
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94143-0648
Practice Address - Country:US
Practice Address - Phone:415-476-9035
Practice Address - Fax:415-514-1532
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-11
Last Update Date:2011-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA30619207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology