Provider Demographics
NPI:1518607514
Name:MOCZYGEMBA, CALLIE JANE (DO)
Entity Type:Individual
Prefix:
First Name:CALLIE
Middle Name:JANE
Last Name:MOCZYGEMBA
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:CALLIE
Other - Middle Name:JANE
Other - Last Name:NANCE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:12141 RICHMOND AVE
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77082-2408
Mailing Address - Country:US
Mailing Address - Phone:512-944-3128
Mailing Address - Fax:
Practice Address - Street 1:12141 RICHMOND AVE
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77082-2408
Practice Address - Country:US
Practice Address - Phone:512-944-3128
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-30
Last Update Date:2022-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program