Provider Demographics
NPI:1386793230
Name:MAZA, CARLOS EDUARDO (MD)
Entity type:Individual
Prefix:DR
First Name:CARLOS
Middle Name:EDUARDO
Last Name:MAZA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:504 PLAZA DRIVE
Mailing Address - Street 2:
Mailing Address - City:SANTA MARIA
Mailing Address - State:CA
Mailing Address - Zip Code:93454-6917
Mailing Address - Country:US
Mailing Address - Phone:805-739-3890
Mailing Address - Fax:805-347-7697
Practice Address - Street 1:117 WEST BUNNY AVENUE
Practice Address - Street 2:
Practice Address - City:SANTA MARIA
Practice Address - State:CA
Practice Address - Zip Code:93458-2805
Practice Address - Country:US
Practice Address - Phone:805-739-3890
Practice Address - Fax:805-347-7697
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2016-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA42083207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA42083OtherMEDICAL LICENSE
CAA42083OtherMEDICAL LICENSE
CAA29503Medicare UPIN