Basic Information
| Provider Information | |||||||||
| NPI: | 1588009625 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MAZARIN | ||||||||
| FirstName: | DANA | ||||||||
| MiddleName: | WRAY | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | HAD | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | KOSINSKI | ||||||||
| OtherFirstName: | DANA | ||||||||
| OtherMiddleName: | WRAY | ||||||||
| OtherNamePrefix: | MISS | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | |||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 5912 BOLSA AVE | ||||||||
| Address2: | STE 201 | ||||||||
| City: | HUNTINGTON BEACH | ||||||||
| State: | CA | ||||||||
| PostalCode: | 926491146 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7148985732 | ||||||||
| FaxNumber: | 7149014058 | ||||||||
| Practice Location | |||||||||
| Address1: | 16030 VENTURA BLVD | ||||||||
| Address2: | STE. 610 | ||||||||
| City: | ENCINO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 914362731 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8187890463 | ||||||||
| FaxNumber: | 8187890732 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/02/2013 | ||||||||
| LastUpdateDate: | 05/28/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 237700000X | 7804 | CA | Y | Speech, Language and Hearing Service Providers | Hearing Instrument Specialist |
No ID Information.