Provider Demographics
NPI:1831143452
Name:MAZZA, DAVID SILVIO (DPM)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:SILVIO
Last Name:MAZZA
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:276 CHURCH AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91910-2729
Mailing Address - Country:US
Mailing Address - Phone:619-427-0311
Mailing Address - Fax:619-427-0327
Practice Address - Street 1:276 CHURCH AVE
Practice Address - Street 2:SUITE A
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91910-2729
Practice Address - Country:US
Practice Address - Phone:619-427-0311
Practice Address - Fax:619-427-0327
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-19
Last Update Date:2010-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE2473213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0E247300Medicaid
CA0E247300Medicaid
CAT11347Medicare UPIN
CA0804020001Medicare NSC