Organization
MARK H MAZUR MD & BARRY STATNER MD A PROFESSIONAL CORPORATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARK H MAZUR MD (PRESIDENT)
(805) 495-1073
Entity
Organization
Contact information
Practice address
375 ROLLING OAKS DR STE 210, THOUSAND OAKS, CA 91361-1028
(805) 495-1073
(805) 495-5836
Mailing address
2220 LYNN RD, SUITE 301, THOUSAND OAKS, CA 91360-8005
(805) 495-1073
(805) 495-5836
Taxonomy
Speciality
Code
Description
License number
State
207RI0200X
Infectious Disease Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GR0078460
—
CA
01
—
ZZZ62326Z
BLUE SHIELD
CA
Enumeration date
10/11/2006
Last updated
07/30/2025
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