Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0210X | Pediatric Nephrologist | MT213894 | PA |
NPI | 1104358449 |
---|---|
Provider Name | Dayna Mazza |
First Address | Philadelphia, PA 19104-4319 |
Second Address | Philadelphia, PA 19104-4319 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/03/2017 |
Last Update Date | 24/06/2020 |