Mazza, Ida Lourdes

Mazza, Ida Lourdes is an sole proprietor health care provider with primary practice located at 711 N Sioux Point Rd , North Sioux City SD 57049-5099. She recently has 2 registered licenses in different health care specialties including Other Service Providers / Specialist, Allopathic & Osteopathic Physicians / Cardiovascular Disease. Allopathic & Osteopathic Physicians / Cardiovascular Disease is her primary health care specialty. Mazza, Ida Lourdes can be contacted via phone (712) 294-7468.

Contact Information

Primary practice address
711 N Sioux Point Rd North Sioux City SD 57049-5099
Phone: (712) 294-7468
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Other Service Providers / Specialist 174400000X
Allopathic & Osteopathic Physicians / Cardiovascular Disease 207RC0000X ME133355 Florida
Allopathic & Osteopathic Physicians / Cardiovascular Disease 207RC0000X MD419073 Pennsylvania

Profile Details

NPI number 1518953850
LBN Legal business name Mazza, Ida Lourdes
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 Yes
Enumeration date Sep 22nd, 2005
Last updated Jan 29th, 2024 - about last year

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1518953850 NPPES
Pennsylvania MEDICAID 0019560820003

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