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Individual

MAYRA BAZAVILVAZO

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
D.M.D

Contact information

Practice address
1012 BRIOSO DR STE 105, COSTA MESA, CA 92627-4544
(305) 298-8797
Mailing address
1401 AVOCADO AVE, 502, NEWPORT BEACH, CA 92660-7720
(949) 640-9554

Taxonomy

Speciality
Code
Description
License number
State
1223P0300X
Periodontics
Primary
60257
CA
1223P0300X
Periodontics
DN17300
FL

Other

Enumeration date
04/27/2011
Last updated
06/10/2016
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