Provider Demographics
NPI:1922605708
Name:ALI, MAZEN
Entity Type:Individual
Prefix:
First Name:MAZEN
Middle Name:
Last Name:ALI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6846 CAMINITO MONTANOSO UNIT 16
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92119-2336
Mailing Address - Country:US
Mailing Address - Phone:619-919-2424
Mailing Address - Fax:
Practice Address - Street 1:6846 CAMINITO MONTANOSO UNIT 16
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92119-2336
Practice Address - Country:US
Practice Address - Phone:619-919-2424
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-05
Last Update Date:2020-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver