Individual
JACK MAZZULO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1200 N STATE ST, LOS ANGELES, CA 90089-1001
(704) 517-4334
Mailing address
11296 SE AQUILA ST, HAPPY VALLEY, OR 97086-7670
(704) 517-4334
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
A197603
CA
Other
Enumeration date
07/28/2019
Last updated
07/15/2025
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