Provider Demographics
NPI:1447037015
Name:MOZON, ANDRE
Entity type:Individual
Prefix:
First Name:ANDRE
Middle Name:
Last Name:MOZON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1901 23RD ST SE APT 181C
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20020-4572
Mailing Address - Country:US
Mailing Address - Phone:202-602-8572
Mailing Address - Fax:
Practice Address - Street 1:1901 23RD ST SE APT 181C
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20020-4572
Practice Address - Country:US
Practice Address - Phone:202-602-8572
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-08
Last Update Date:2023-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant