Provider Demographics
NPI:1710294418
Name:MOCZYGEMBA, MARSHA D (LVN)
Entity Type:Individual
Prefix:MRS
First Name:MARSHA
Middle Name:D
Last Name:MOCZYGEMBA
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8715 VILLAGE DR STE 518
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78217-5423
Mailing Address - Country:US
Mailing Address - Phone:210-656-5098
Mailing Address - Fax:210-656-5219
Practice Address - Street 1:8811 VILLAGE DR
Practice Address - Street 2:STE 150
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78217-5415
Practice Address - Country:US
Practice Address - Phone:210-656-5098
Practice Address - Fax:210-656-5219
Is Sole Proprietor?:No
Enumeration Date:2010-09-02
Last Update Date:2019-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX149154164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse