Provider Demographics
NPI:1336551969
Name:MARIANNE HAZELITT DO PROFESSIONAL ASSOCIATION
Entity Type:Organization
Organization Name:MARIANNE HAZELITT DO PROFESSIONAL ASSOCIATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARIANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:HAZELITT
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:310-408-0227
Mailing Address - Street 1:4181 SOUNDSIDE DR # B
Mailing Address - Street 2:NONE
Mailing Address - City:GULF BREEZE
Mailing Address - State:FL
Mailing Address - Zip Code:32563-9134
Mailing Address - Country:US
Mailing Address - Phone:310-408-0227
Mailing Address - Fax:
Practice Address - Street 1:4181 SOUNDSIDE DR # B
Practice Address - Street 2:NONE
Practice Address - City:GULF BREEZE
Practice Address - State:FL
Practice Address - Zip Code:32563-9134
Practice Address - Country:US
Practice Address - Phone:310-408-0227
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-02
Last Update Date:2014-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS12016207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty