Provider Demographics
NPI:1457448516
Name:JEFFREY B. MAZIN,M.D.,F.A.C.S.,INC.
Entity Type:Organization
Organization Name:JEFFREY B. MAZIN,M.D.,F.A.C.S.,INC.
Other - Org Name:HERNIA SURGICAL SPECIALISTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:BYRON
Authorized Official - Last Name:MAZIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:858-272-9996
Mailing Address - Street 1:3737 MORAGA AVE
Mailing Address - Street 2:SUITE B 412
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92117-5404
Mailing Address - Country:US
Mailing Address - Phone:858-272-9996
Mailing Address - Fax:858-272-9959
Practice Address - Street 1:3737 MORAGA AVE
Practice Address - Street 2:SUITE B 412
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92117-5404
Practice Address - Country:US
Practice Address - Phone:858-272-9996
Practice Address - Fax:858-272-9959
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-09
Last Update Date:2010-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG41431208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G414310Medicaid
CAG41431Medicare ID - Type UnspecifiedMEDICARE
CA00G414310Medicaid