Provider Demographics
NPI:1891862116
Name:MAZZA, MONIQUE MARIE (ND)
Entity Type:Individual
Prefix:DR
First Name:MONIQUE
Middle Name:MARIE
Last Name:MAZZA
Suffix:
Gender:F
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 ROBINSON AVE
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92103-4006
Mailing Address - Country:US
Mailing Address - Phone:610-794-0164
Mailing Address - Fax:616-794-0165
Practice Address - Street 1:111 ROBINSON AVE
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-4006
Practice Address - Country:US
Practice Address - Phone:610-794-0164
Practice Address - Fax:616-794-0165
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANDF-34175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath