Jack Mazzulo, MD

Primary specialty

Emergency Medicine PhysicianTaxonomy code 207P00000X

License

A197603 Issued in CA

Practice address

1200 N State St
Los Angeles, CA 90089-1001

Phone

(704) 517-4334

NPI assigned

Jul 28, 2019

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

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: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Emergency Medicine

Education

Oregon Health & Sciences Univ School of Dentistry, 2021

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Southern California Emergency Medical GroupGroup PAC ID 4688097066, 24 clinicians

Burbank Emergency Medical Group IncGroup PAC ID 2961308036, 29 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Providence Little Co of Mary Med Ctr San Pedro Hospital, San Pedro, CA, CCN 050078
• Providence Saint Joseph Medical Ctr Hospital, Burbank, CA, CCN 050235

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

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

• Burbank Emergency Medical Group Inc

  • Emergency Medicine Physician
  • Burbank, CA
  • NPI 1689636730
  Medicare reassignment Care Compare group NPD
• Southern California Emergency Medical Group

  • Emergency Medicine Physician
  • San Pedro, CA
  • NPI 1518588433
  Medicare reassignment Care Compare group NPD

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Providence Health System - Southern California

  • General Acute Care Hospital
  • Burbank, CA
  • NPI 1336173269
  Care Compare affiliation
• Providence Health System - Southern California

  • General Acute Care Hospital
  • San Pedro, CA
  • NPI 1497241541
  Care Compare affiliation
• Providence Health System - Southern California

  • General Acute Care Hospital
  • San Pedro, CA
  • NPI 1942247291
  Care Compare affiliation

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

{
    "created_epoch": "1564272000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1752537600000",
    "number": "1518511690",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11296 SE AQUILA ST",
            "city": "HAPPY VALLEY",
            "state": "OR",
            "postal_code": "970867670",
            "telephone_number": "704-517-4334"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1200 N STATE ST",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900891001",
            "telephone_number": "704-517-4334"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MAZZULO",
        "first_name": "JACK",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-07-28",
        "last_updated": "2025-07-15",
        "certification_date": "2025-07-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "CA",
            "license": "A197603",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Amanda Spicer Mazza, M.D.
• Malek Mazzawi, M.D.
• Heather Mazzei
• John C Mazziotta, M.D.
• Marie Ellen Mazzone, D.D.S.
• MB Physical Therapy PC
• Mba Psychiatric Services, Inc.
• Helena O Mba, MD
• Chika Mbadugha, PHYSICIAN ASSISTANT
• Florence Mbanu

• Emergency Medicine Physician in Los Angeles, CA
• Providers in Los Angeles, CA by specialty
• Emergency Medicine Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 15, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.