Provider Demographics
NPI:1699504431
Name:MAZY, NAOMI LOUISE (LMT)
Entity type:Individual
Prefix:
First Name:NAOMI
Middle Name:LOUISE
Last Name:MAZY
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1062 37TH ST APT B
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94608-3915
Mailing Address - Country:US
Mailing Address - Phone:610-698-8496
Mailing Address - Fax:
Practice Address - Street 1:1062 37TH ST APT B
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94608-3915
Practice Address - Country:US
Practice Address - Phone:610-698-8496
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-30
Last Update Date:2024-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA21992225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist