Provider Demographics
NPI:1104660554
Name:MAZUROWSKI, KYLE
Entity type:Individual
Prefix:
First Name:KYLE
Middle Name:
Last Name:MAZUROWSKI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14849 N KINGS WAY UNIT 223
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN HILLS
Mailing Address - State:AZ
Mailing Address - Zip Code:85268-2974
Mailing Address - Country:US
Mailing Address - Phone:480-387-9721
Mailing Address - Fax:
Practice Address - Street 1:8850 E PIMA CENTER PKWY
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85258-4619
Practice Address - Country:US
Practice Address - Phone:480-800-3900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-20
Last Update Date:2024-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ274375376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide