Individual
MR. MAZEN MUHAMMAD MARDINI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
999 S FAIRMONT AVE, #115, LODI, CA 95240
(209) 334-6325
(209) 334-4651
Mailing address
999 S FAIRMONT AVE, #115, LODI, CA 95240
(209) 334-6325
(209) 334-4651
Taxonomy
Speciality
Code
Description
License number
State
207RG0100X
Gastroenterology Physician
Primary
A35332
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00A353320
—
CA
01
—
942676155
FED ID
—
Enumeration date
06/11/2006
Last updated
03/03/2010
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