Basic Information
| Provider Information | |||||||||
| NPI: | 1861960544 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MAZARIEGO | ||||||||
| FirstName: | MARIA | ||||||||
| MiddleName: | MARIBEL | ||||||||
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| Credential: | COTA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5583 WALNUT BLOSSOM DR | ||||||||
| Address2: | |||||||||
| City: | SAN JOSE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 951232281 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8622039649 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2500 COUNTRY DR | ||||||||
| Address2: | |||||||||
| City: | FREMONT | ||||||||
| State: | CA | ||||||||
| PostalCode: | 945365356 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5107924242 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/11/2018 | ||||||||
| LastUpdateDate: | 11/11/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 224Z00000X | OTA4586 | CA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapy Assistant |
No ID Information.