Provider Demographics
NPI:1790470102
Name:MAZON BOCANEGRA, NUVIA ELIZABETH (COTA/L)
Entity Type:Individual
Prefix:
First Name:NUVIA
Middle Name:ELIZABETH
Last Name:MAZON BOCANEGRA
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6854 S PORTUGAL AVE
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85757-0017
Mailing Address - Country:US
Mailing Address - Phone:520-406-6772
Mailing Address - Fax:
Practice Address - Street 1:3920 E 5TH ST
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85711-1917
Practice Address - Country:US
Practice Address - Phone:520-471-0283
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-11
Last Update Date:2023-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZOTA-047029224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant