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Individual

DR. ANTHONY A. MAZZARULLI

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
1601 CUMMINS DR STE D, MODESTO, CA 95358-6411
(510) 900-3125
Mailing address
1601 CUMMINS DR STE D, MODESTO, CA 95358-6411
(510) 900-3125

Taxonomy

Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
2010-02091
NC
2084N0400X
Neurology Physician
C147508
CA
2084N0400X
Neurology Physician
MD180163
OR
2084P0800X
Psychiatry Physician
2010-02091
NC
2084P0800X
Psychiatry Physician
Primary
C147508
CA
2084P0800X
Psychiatry Physician
M6752
TX

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
1801090006
NC
05
194605502
TX
05
5916730
NC
01
BP1-0026742
INSTITUTIONAL PERMIT
05
NC1329
SC
Enumeration date
06/12/2007
Last updated
07/20/2022
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