Provider Demographics
NPI:1831948470
Name:MIZE, TONY CARLOS
Entity type:Individual
Prefix:
First Name:TONY
Middle Name:CARLOS
Last Name:MIZE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14030 CONNECTICUT AVE UNIT 9631
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20916-7667
Mailing Address - Country:US
Mailing Address - Phone:240-681-5342
Mailing Address - Fax:
Practice Address - Street 1:2331 CATHEDRAL AVE NW APT 105
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20008-1552
Practice Address - Country:US
Practice Address - Phone:240-681-5342
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-16
Last Update Date:2024-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant