| Doctor Name: | MIGUEL ANGEL MAZARIEGOS |
| NPI Number: | 1255325361 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | MD |
| License Number: | ME0069553 |
| Business Practice Address: | 205 S Moon Ave Suite 105 Brandon, FL - 335115716 |
| Business Phone Number: | 8136816064 |
| Business Fax Number: | 8136534132 |
| Mailing Address: | 205 S Moon Ave, Suite 105 BRANDON |
| State: | FL |
| Postal Code: | 335115716 |
| Phone Number: | 8136816064 |
| Fax Number: | 8136534132 |
| NPI Enumeration Date: | 09/02/2005 |
| NPI Last Update Date: | 06/15/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | ME0069553 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | FL |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |