Provider Demographics
NPI:1861641193
Name:MAZARIEGO, ROSA ELENA
Entity Type:Individual
Prefix:
First Name:ROSA
Middle Name:ELENA
Last Name:MAZARIEGO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8320 IOWA ST
Mailing Address - Street 2:
Mailing Address - City:DOWNEY
Mailing Address - State:CA
Mailing Address - Zip Code:90241-4928
Mailing Address - Country:US
Mailing Address - Phone:562-904-4815
Mailing Address - Fax:
Practice Address - Street 1:8320 IOWA ST STE 201
Practice Address - Street 2:
Practice Address - City:DOWNEY
Practice Address - State:CA
Practice Address - Zip Code:90241-4928
Practice Address - Country:US
Practice Address - Phone:562-904-4815
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-10
Last Update Date:2021-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA648141041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical