| Mark H Mazur Md & Barry Statner Md A Professional Corporation | |
|
2220 Lynn Rd Suite 301 Thousand Oaks CA 91360-8005 | |
| (805) 495-1073 | |
| (805) 495-5836 |
| Full Name | Mark H Mazur Md & Barry Statner Md A Professional Corporation |
|---|---|
| Speciality | Internal Medicine |
| Location | 2220 Lynn Rd, Thousand Oaks, California |
| Authorized Official Name and Position | Mark H Mazur (PRESIDENT) |
| Authorized Official Contact | 8054951073 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Mark H Mazur Md & Barry Statner Md A Professional Corporation 2220 Lynn Rd Suite 301 Thousand Oaks CA 91360-8005 Ph: (805) 495-1073 | Mark H Mazur Md & Barry Statner Md A Professional Corporation 2220 Lynn Rd Suite 301 Thousand Oaks CA 91360-8005 Ph: (805) 495-1073 |
| NPI Number | 1376631341 |
|---|---|
| Provider Enumeration Date | 10/11/2006 |
| Last Update Date | 10/28/2011 |
| Medicare PECOS PAC ID | 1254373806 |
|---|---|
| Medicare Enrollment ID | O20050524001355 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1376631341 | NPI | - | NPPES |
| GR0078460 | Medicaid | CA | |
| ZZZ62326Z | Other | CA | BLUE SHIELD |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207RI0200X | Internal Medicine - Infectious Disease | (* (Not Available)) | Primary |
| Provider Name | Ramesh V Nathan |
|---|---|
| Provider Type | Practitioner - Infectious Disease |
| Provider Identifiers | NPI Number: 1215025291 PECOS PAC ID: 1951349141 Enrollment ID: I20050419000677 |
| Provider Name | Carolyn Kelly |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1639283286 PECOS PAC ID: 0547268955 Enrollment ID: I20061120000216 |
| Provider Name | Sujay Dutta |
|---|---|
| Provider Type | Practitioner - Infectious Disease |
| Provider Identifiers | NPI Number: 1184712168 PECOS PAC ID: 6002814076 Enrollment ID: I20061129000546 |
| Provider Name | Barry Statner |
|---|---|
| Provider Type | Practitioner - Infectious Disease |
| Provider Identifiers | NPI Number: 1740378728 PECOS PAC ID: 3173704558 Enrollment ID: I20110217000532 |
| Provider Name | Andrew Ma |
|---|---|
| Provider Type | Practitioner - Infectious Disease |
| Provider Identifiers | NPI Number: 1528299708 PECOS PAC ID: 7517288178 Enrollment ID: I20150608001591 |
| Provider Name | Marina N Estrada |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1235598749 PECOS PAC ID: 6901105717 Enrollment ID: I20160429000321 |
| Provider Name | Andre Cristian De Jesus |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1023549037 PECOS PAC ID: 2466795547 Enrollment ID: I20190513000264 |
| Provider Name | Desiree Lene Steinberg |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1043877939 PECOS PAC ID: 2466786264 Enrollment ID: I20190627003308 |
| Provider Name | Chantel D R Bachman |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1609492123 PECOS PAC ID: 5597180323 Enrollment ID: I20200810003473 |
| Provider Name | Fides D Antonio |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1609462845 PECOS PAC ID: 2769896984 Enrollment ID: I20210129002108 |
| Provider Name | Amanda Spino |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1750939526 PECOS PAC ID: 0547679714 Enrollment ID: I20210429002840 |
| Provider Name | Brandi Elyse Ford |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1134836133 PECOS PAC ID: 1759752777 Enrollment ID: I20230130000763 |
| Provider Name | Bharathi Rasagolla |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1649855727 PECOS PAC ID: 9032568878 Enrollment ID: I20231205004000 |
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