Maricela A Mazuca, PA

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

PA03610 Issued in TX

Practice address

1202 E. Sonterra Blvd Suite 102
San Antonio, TX 78258

Phone

(210) 271-3203

Fax

(210) 733-6983

NPI assigned

Jul 18, 2005

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Opted out of Medicare

Yes, effective Oct 1, 2024 through Oct 1, 2026

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

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.

• Central Cardiovascular Institute of San Antonio

  • Specialist
  • San Antonio, TX
  • NPI 1184618050
  NPD (past)
• Clinic Service Providers, PA

  • Family Medicine Physician
  • Houston, TX
  • NPI 1568797496
  NPD (past)
• First Family Clinic, Inc.

  • Family Medicine Physician
  • San Antonio, TX
  • NPI 1548451255
  NPD (past)

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

{
    "created_epoch": "1121644800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1579046400000",
    "number": "1770582173",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1202 E. SONTERRA BLVD SUITE 102",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "78258",
            "telephone_number": "210-305-5075",
            "fax_number": "830-730-5082"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1202 E. SONTERRA BLVD SUITE 102",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "78258",
            "telephone_number": "210-271-3203",
            "fax_number": "210-733-6983"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MAZUCA",
        "first_name": "MARICELA",
        "middle_name": "A",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-07-18",
        "last_updated": "2020-01-15",
        "certification_date": "2020-01-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "TX",
            "license": "PA03610",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "8N4388",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Bassem Mazloum, M.D.
• Tracy Mazloum, LPC
• Marcela Mazo Canola, M.D.
• Melody Nicole Mazon
• Cynthia Z. Mazuca, LCSW
• Tim Mazuca, PTA
• Bhaskar Mazumdar, M.D.
• Sarmistha Mazumder
• Stephanie Villasenor Mazurak, LVN
• Kagen Troy Mazurek

• Medical Physician Assistant in San Antonio, TX
• Providers in San Antonio, TX by specialty
• Medical Physician Assistant in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 15, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.