Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | J7079 | TX |
N | 2080P0208X | Pediatric Infectious Diseases | J7079 | TX |
NPI | 1598714446 |
---|---|
Provider Name | Dr. Jorge Carlos Mazzini |
First Address | Brownsville, TX 78521-2524 |
Second Address | Brownsville, TX 78521-2524 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/05/2006 |
Last Update Date | 28/02/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
116856 | SUPERIOR/CHIP (01) | TX |
133201704 | (05) | TX |
133201706 | (05) | TX |
133201707 | (05) | TX |
742857385 | TAX ID (01) | TX |