Provider Demographics
NPI:1679628036
Name:MAZOUZ, MICHEL J (MD)
Entity Type:Individual
Prefix:
First Name:MICHEL
Middle Name:J
Last Name:MAZOUZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Last Name:
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Mailing Address - Street 1:PO BOX 67218
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90067-0218
Mailing Address - Country:US
Mailing Address - Phone:310-201-0626
Mailing Address - Fax:
Practice Address - Street 1:1125 S BEVERLY DR STE 730
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90035-1180
Practice Address - Country:US
Practice Address - Phone:310-201-0626
Practice Address - Fax:310-277-2852
Is Sole Proprietor?:No
Enumeration Date:2007-01-24
Last Update Date:2015-07-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA44045207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A440450Medicaid
CA00A440450Medicaid
CAE20153Medicare UPIN