Provider Demographics
NPI:1154544674
Name:MAZON, RAY (DOM LAC)
Entity type:Individual
Prefix:DR
First Name:RAY
Middle Name:
Last Name:MAZON
Suffix:
Gender:M
Credentials:DOM LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3501
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87190-3501
Mailing Address - Country:US
Mailing Address - Phone:505-255-0048
Mailing Address - Fax:505-256-1487
Practice Address - Street 1:2724 VASSAR PL NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87107-1869
Practice Address - Country:US
Practice Address - Phone:505-255-0048
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-11
Last Update Date:2010-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM463171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist