Provider Demographics
NPI:1023599230
Name:MAZZULLO, JOSEPH JACOB (PMHNP)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:JACOB
Last Name:MAZZULLO
Suffix:
Gender:M
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 10748
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93389-0748
Mailing Address - Country:US
Mailing Address - Phone:661-431-1555
Mailing Address - Fax:661-471-2410
Practice Address - Street 1:8329 BRIMHALL ROAD
Practice Address - Street 2:SUITE 804
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93312-2243
Practice Address - Country:US
Practice Address - Phone:661-431-1555
Practice Address - Fax:661-471-2410
Is Sole Proprietor?:No
Enumeration Date:2018-08-25
Last Update Date:2022-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA666305163WP0808X, 163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
1149863059OtherVETERANS ADMINISTRATION