Provider Demographics
NPI:1710744883
Name:GATABAZI, MAZIMPAKA FREDDY
Entity Type:Individual
Prefix:
First Name:MAZIMPAKA
Middle Name:FREDDY
Last Name:GATABAZI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5925 MILLSHIRE DR APT 2D
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45440-4132
Mailing Address - Country:US
Mailing Address - Phone:937-895-5181
Mailing Address - Fax:
Practice Address - Street 1:5925 MILLSHIRE DR APT 2D
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45440-4132
Practice Address - Country:US
Practice Address - Phone:937-895-5181
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-04
Last Update Date:2024-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide