Provider Demographics
NPI:1902018666
Name:ALLY, MAZER RICKY (MD)
Entity Type:Individual
Prefix:DR
First Name:MAZER
Middle Name:RICKY
Last Name:ALLY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10790 RANCHO BERNARDO RD
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92127-5705
Mailing Address - Country:US
Mailing Address - Phone:760-704-5870
Mailing Address - Fax:
Practice Address - Street 1:2205 VISTA WAY STE 340
Practice Address - Street 2:
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92054-5661
Practice Address - Country:US
Practice Address - Phone:760-704-5870
Practice Address - Fax:760-404-1821
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-04
Last Update Date:2021-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA146924207RG0100X, 207RG0100X
MD207R00000X207R00000X
HI17449207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine