Provider Demographics
NPI:1740831031
Name:WHITE, MAZATTA D
Entity type:Individual
Prefix:MS
First Name:MAZATTA
Middle Name:D
Last Name:WHITE
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 1:1919 RUNNELS ST.
Mailing Address - Street 2:APT #86
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77003
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1919 RUNNELS ST.
Practice Address - Street 2:APT #86
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77003
Practice Address - Country:US
Practice Address - Phone:346-314-6951
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-27
Last Update Date:2019-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider