Individual
DR. THEODORE M. MAZER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
6699 ALVARADO RD, STE 2209, SAN DIEGO, CA 92120-5240
(619) 583-8990
(619) 265-1114
Mailing address
6699 ALVARADO RD, STE 2209, SAN DIEGO, CA 92120-5240
(619) 583-8990
(619) 265-1114
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
Primary
A43828
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00A438280
—
CA
01
—
A43828
STATE LICIENCE
CA
Enumeration date
05/24/2005
Last updated
02/19/2020
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