Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2100X | Nurse Practitioner - Acute Care | 95010718 | CA |
NPI | 1023580446 |
---|---|
Provider Name | Deirdre Alice Mazzetto |
First Address | Merced, CA 95341-6250 |
Second Address | Merced, CA 95341-6250 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/12/2018 |
Last Update Date | 08/02/2021 |