Organization
BREVARD NEURO CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOSSE ANTHONY MAZO-MAYORQUIN MD (MD/OWNER)
(321) 733-2711
Entity
Organization
Contact information
Practice address
315 E NASA BLVD, MELBOURNE, FL 32901-1939
(321) 733-2711
(321) 733-2011
Mailing address
315 E NASA BLVD, MELBOURNE, FL 32901-1939
(321) 733-2711
(321) 733-2011
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
ME89659
FL
Other
Enumeration date
10/22/2013
Last updated
09/29/2014
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