Provider Demographics
NPI:1972259919
Name:MAZUR, NATHANIEL DAVIN RUSH
Entity type:Individual
Prefix:MR
First Name:NATHANIEL
Middle Name:DAVIN RUSH
Last Name:MAZUR
Suffix:
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:NATE
Other - Middle Name:
Other - Last Name:MAZUR
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:15400 VINEYARD BLVD.
Mailing Address - Street 2:APT. 421
Mailing Address - City:MORGAN HILL
Mailing Address - State:CA
Mailing Address - Zip Code:95037
Mailing Address - Country:US
Mailing Address - Phone:408-722-6175
Mailing Address - Fax:
Practice Address - Street 1:7500 ARROYO CIRCLE
Practice Address - Street 2:SUITE 180
Practice Address - City:GIRLOY
Practice Address - State:CA
Practice Address - Zip Code:95020
Practice Address - Country:US
Practice Address - Phone:408-859-6522
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-28
Last Update Date:2022-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician