Provider Demographics
NPI:1457900169
Name:CHASSON-FORREST, MAZAL
Entity Type:Individual
Prefix:
First Name:MAZAL
Middle Name:
Last Name:CHASSON-FORREST
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4285 N RANCHO DR STE 160
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89130-3456
Mailing Address - Country:US
Mailing Address - Phone:702-685-3459
Mailing Address - Fax:702-851-8528
Practice Address - Street 1:4285 N RANCHO DR STE 160
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89130-3456
Practice Address - Country:US
Practice Address - Phone:702-685-3459
Practice Address - Fax:702-851-8528
Is Sole Proprietor?:No
Enumeration Date:2019-09-05
Last Update Date:2019-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner