Provider Demographics
NPI:1750302204
Name:MOZELSIO, MICHELE (PA)
Entity Type:Individual
Prefix:MS
First Name:MICHELE
Middle Name:
Last Name:MOZELSIO
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1426 WALLER ST APT 6
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94117-2954
Mailing Address - Country:US
Mailing Address - Phone:415-863-4048
Mailing Address - Fax:
Practice Address - Street 1:50 LECH WALESA
Practice Address - Street 2:TOM WADDELL HEALTH CENTER
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94102-4506
Practice Address - Country:US
Practice Address - Phone:415-355-7400
Practice Address - Fax:415-355-7402
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA17712363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical