Ivan L Mazzorana Jr MD PA

NPI #1790877488 in Ft Myers, Florida

Provider Information

NPI Number: 1790877488
Entity Type: Organization
Organization Name: Ivan L Mazzorana Jr MD PA
Primary Specialty: Psychiatry & Neurology - Psychiatry
Enumeration Date: Sep 29, 2006
Last Updated: Nov 15, 2012

Practice Location

Address: 12590 WHITEHALL DR
Address 2: SUITE 3
City: Ft Myers
State: Florida
ZIP Code: 33907-3620
Phone: (239) 939-9090

Authorized Official

Name: IVAN L MAZZORANA JR., MD
Title: PRESIDENT
Phone: (239) 939-9090

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Psychologist	103T00000X
Nurse Practitioner - Psychiatric/Mental Health — Psychiatric/Mental Health	363LP0808X
Psychiatry & Neurology - Psychiatry — Psychiatry	2084P0800X	Primary

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