Provider Demographics
NPI:1790129450
Name:MAZALIC, DEBORAH KATHLEEN (DOA CERTIFICATE)
Entity Type:Individual
Prefix:MS
First Name:DEBORAH
Middle Name:KATHLEEN
Last Name:MAZALIC
Suffix:
Gender:F
Credentials:DOA CERTIFICATE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2294 KENDALL DR
Mailing Address - Street 2:APT #A4
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92407-4667
Mailing Address - Country:US
Mailing Address - Phone:909-380-1538
Mailing Address - Fax:
Practice Address - Street 1:1874 BUSINESS CENTER DR
Practice Address - Street 2:
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92408-3457
Practice Address - Country:US
Practice Address - Phone:909-386-0523
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-24
Last Update Date:2013-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)