Provider Demographics
NPI:1912726316
Name:MAZAREI, LEELA
Entity type:Individual
Prefix:
First Name:LEELA
Middle Name:
Last Name:MAZAREI
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8239 ROCHESTER AVE
Mailing Address - Street 2:
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91730-0714
Mailing Address - Country:US
Mailing Address - Phone:909-941-0266
Mailing Address - Fax:
Practice Address - Street 1:8239 ROCHESTER AVE
Practice Address - Street 2:
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730-0714
Practice Address - Country:US
Practice Address - Phone:909-941-0266
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-03
Last Update Date:2025-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant