Provider Demographics
NPI:1457584799
Name:MAZZIE, ALBERT F (MD)
Entity Type:Individual
Prefix:
First Name:ALBERT
Middle Name:F
Last Name:MAZZIE
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 1:400 30TH ST.
Mailing Address - Street 2:SUITE 203
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94609
Mailing Address - Country:US
Mailing Address - Phone:510-836-8929
Mailing Address - Fax:510-836-8939
Practice Address - Street 1:400 30TH ST.
Practice Address - Street 2:SUITE 203
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94609
Practice Address - Country:US
Practice Address - Phone:510-836-8929
Practice Address - Fax:510-836-8939
Is Sole Proprietor?:No
Enumeration Date:2009-09-03
Last Update Date:2009-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA28806207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine