Active NPI
David John Mazzola
- Child Mental Illness Respite Care
- Tucson, AZ
National Provider Identifier
1033317862
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Child Mental Illness Respite Care
- License
- 9209
- Practice address
- 3151 E Holladay St
Tucson, AZ 85706-2819 - Phone
- (520) 889-2453
- NPI assigned
- Jul 3, 2007
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Child Mental Illness Respite Care | 385HR2055X | 9209 | AZ | Primary |
Addresses
Primary practice location
3151 E Holladay St
Tucson, AZ 85706-2819
Mailing address
3151 E Holladay St
Tucson, AZ 85706-2819
Phone (520) 889-2453
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 894429 | Medicaid | AZ |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 9209 | AZ | MD | Emergency Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1183420800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183939200000",
"number": "1033317862",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3151 E HOLLADAY ST",
"city": "TUCSON",
"state": "AZ",
"postal_code": "857062819",
"telephone_number": "520-889-2453"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3151 E HOLLADAY ST",
"city": "TUCSON",
"state": "AZ",
"postal_code": "857062819",
"telephone_number": "520-889-2453"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MAZZOLA",
"first_name": "DAVID",
"middle_name": "JOHN",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-07-03",
"last_updated": "2007-07-09",
"status": "A"
},
"taxonomies": [
{
"code": "385HR2055X",
"taxonomy_group": "",
"desc": "Respite Care, Respite Care, Mental Illness, Child",
"state": "AZ",
"license": "9209",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "894429",
"state": "AZ"
}
],
"endpoints": [],
"other_names": []
}Other providers in Tucson, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.