Active NPI
Nicholas Mazzuca, RRA
- Radiology Practitioner Assistant
- Hollywood, FL
National Provider Identifier
1184460677
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Radiology Practitioner Assistant
- License
- RA165
- Practice address
- 3501 Johnson St
Hollywood, FL 33021-5421 - Phone
- (954) 987-2000
- NPI assigned
- Jul 3, 2024
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Vascular-Interventional Technology Radiologic Technologist | 2471V0106X | CRT39545 | FL | |
| Radiology Practitioner Assistant | 243U00000X | RA165 | FL | Primary |
Addresses
Primary practice location
3501 Johnson St
Hollywood, FL 33021-5421
Mailing address
5769 SW 42ND Ter
Miami, FL 33155-5313
Phone (786) 348-3595
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| RA165 | FL | MD | Radiology Practitioner Assistant |
| CRT39545 | FL | MD | Vascular-Interventional Technology Radiologic Technologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1719964800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1719964800000",
"number": "1184460677",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5769 SW 42ND TER",
"city": "MIAMI",
"state": "FL",
"postal_code": "331555313",
"telephone_number": "786-348-3595"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3501 JOHNSON ST",
"city": "HOLLYWOOD",
"state": "FL",
"postal_code": "330215421",
"telephone_number": "954-987-2000"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MAZZUCA",
"first_name": "NICHOLAS",
"credential": "RRA",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2024-07-03",
"last_updated": "2024-07-03",
"certification_date": "2024-07-03",
"status": "A"
},
"taxonomies": [
{
"code": "2471V0106X",
"taxonomy_group": "",
"desc": "Radiologic Technologist, Vascular-Interventional Technology",
"state": "FL",
"license": "CRT39545",
"primary": false
},
{
"code": "243U00000X",
"taxonomy_group": "",
"desc": "Radiology Practitioner Assistant",
"state": "FL",
"license": "RA165",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Hollywood, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 3, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.