Individual provider Active NPI

Laurie Jeanne Mazzei, PA-C

  • Medical Physician Assistant
  • Tustin, CA
National Provider Identifier
1093994659
Registry record updated Jun 17, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
PA19430 Issued in CA
Practice address
1 Hope Dr
Tustin, CA 92782-0221
Phone
(714) 247-0300
Fax
(714) 259-1598
NPI assigned
Oct 31, 2007
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jun 17, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X PA19430 CA Primary

Addresses

Primary practice location

1 Hope Dr
Tustin, CA 92782-0221

Mailing address

1 Hope Dr
Tustin, CA 92782-0221
Phone (714) 247-0300

Other practice location 1

32605 Temecula Pkwy
Temecula, CA 92592-6837
Phone (951) 506-9112

Other practice location 2

947 S Anaheim Blvd Ste 260
Anaheim, CA 92805-5591
Phone (714) 247-0300

Other practice location 3

1100B N Tustin Ave # A
Santa Ana, CA 92705-3505
Phone (714) 247-0300

Other practice location 4

14642 Newport Ave Ste 200
Tustin, CA 92780-6058
Phone (714) 247-0300

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20080522000262 CA Practitioner - Physician Assistant 1557430147 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
PA19430CAMDMedical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Hurtt Family Health Clinic Inc. CurrentSince Apr 29, 2019 Accepting new patients
Allen Medical Group, Inc. PastSince Jul 18, 2012 Accepting new patients

Locations

947 S Anaheim Blvd
Ste 260
Anaheim, CA 92805

1100 N Tustin Ave
Ste A
Santa Ana, CA 92705
Phone (714) 835-6055

1 Hope Dr
Ste B
Tustin, CA 92782

14642 Newport Ave
Ste 200
Tustin, CA 92780
Phone (714) 669-4466

1 Hope Dr
Tustin, CA 92782
Phone (714) 247-4398

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1193788800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1623888000000",
    "number": "1093994659",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 HOPE DR",
            "city": "TUSTIN",
            "state": "CA",
            "postal_code": "927820221",
            "telephone_number": "714-247-0300",
            "fax_number": "714-259-1598"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 HOPE DR",
            "city": "TUSTIN",
            "state": "CA",
            "postal_code": "927820221",
            "telephone_number": "714-247-0300",
            "fax_number": "714-259-1598"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "32605 Temecula Pkwy",
            "address_purpose": "LOCATION",
            "city": "Temecula",
            "state": "CA",
            "postal_code": "925926837",
            "country_code": "US",
            "telephone_number": "951-506-9112",
            "fax_number": "951-506-9112",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "947 S Anaheim Blvd Ste 260",
            "address_purpose": "LOCATION",
            "city": "Anaheim",
            "state": "CA",
            "postal_code": "928055591",
            "country_code": "US",
            "telephone_number": "714-247-0300",
            "fax_number": "714-259-1598",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1100B N Tustin Ave # A",
            "address_purpose": "LOCATION",
            "city": "Santa Ana",
            "state": "CA",
            "postal_code": "927053505",
            "country_code": "US",
            "telephone_number": "714-247-0300",
            "fax_number": "714-259-1598",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "14642 Newport Ave Ste 200",
            "address_purpose": "LOCATION",
            "city": "Tustin",
            "state": "CA",
            "postal_code": "927806058",
            "country_code": "US",
            "telephone_number": "714-247-0300",
            "fax_number": "714-259-1598",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MAZZEI",
        "first_name": "LAURIE",
        "middle_name": "JEANNE",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-10-31",
        "last_updated": "2021-06-17",
        "certification_date": "2021-06-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "CA",
            "license": "PA19430",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Tustin, CA

Sources for this page

Verify at the official NPI Registry.