Provider Demographics
NPI:1811285711
Name:HAZDOVAC, MARY CATHERINE
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:CATHERINE
Last Name:HAZDOVAC
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:CATHERINE
Other - Last Name:CLARK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1117 PIEDMONT AVE
Mailing Address - Street 2:
Mailing Address - City:PACIFIC GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:93950-5422
Mailing Address - Country:US
Mailing Address - Phone:831-277-4107
Mailing Address - Fax:
Practice Address - Street 1:1270 NATIVIDAD RD
Practice Address - Street 2:
Practice Address - City:SALINAS
Practice Address - State:CA
Practice Address - Zip Code:93906-3122
Practice Address - Country:US
Practice Address - Phone:831-755-4510
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-13
Last Update Date:2011-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program