Individual
DIANE MARIE MAZZONI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MS, PPS
Contact information
Practice address
37479 AVENUE 12, MADERA, CA 93636-8726
(559) 645-3572
Mailing address
17549 ROAD 36 1/2, MADERA, CA 93636-9207
(559) 363-2583
Taxonomy
Speciality
Code
Description
License number
State
103TS0200X
School Psychologist
Primary
2326
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
91-2129526
MEDI-CAL
CA
Enumeration date
06/05/2019
Last updated
06/05/2019
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