Provider Demographics
NPI:1992903520
Name:MAZZELLA, CARMELA
Entity type:Individual
Prefix:
First Name:CARMELA
Middle Name:
Last Name:MAZZELLA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1591 GREEN VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:94526-1956
Mailing Address - Country:US
Mailing Address - Phone:925-872-4818
Mailing Address - Fax:
Practice Address - Street 1:1591 GREEN VALLEY RD
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:CA
Practice Address - Zip Code:94526-1956
Practice Address - Country:US
Practice Address - Phone:925-872-4818
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA3932235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist