Provider Demographics
NPI:1891001541
Name:MAZO, ANDREA DAWN (BCBA)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:DAWN
Last Name:MAZO
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23811 WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:MURRIETA
Mailing Address - State:CA
Mailing Address - Zip Code:92562-2275
Mailing Address - Country:US
Mailing Address - Phone:951-290-1175
Mailing Address - Fax:951-304-0390
Practice Address - Street 1:41690 ENTERPRISE CIR N
Practice Address - Street 2:
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92590-5616
Practice Address - Country:US
Practice Address - Phone:951-290-1175
Practice Address - Fax:951-304-0390
Is Sole Proprietor?:No
Enumeration Date:2010-08-19
Last Update Date:2023-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103K00000X
CA1-14-17175103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst