Provider Demographics
NPI:1881372498
Name:VOZZA, MARIO ANTONIO (CST/CSFA)
Entity type:Individual
Prefix:
First Name:MARIO
Middle Name:ANTONIO
Last Name:VOZZA
Suffix:
Gender:M
Credentials:CST/CSFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 222031
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79913-5031
Mailing Address - Country:US
Mailing Address - Phone:915-549-2170
Mailing Address - Fax:
Practice Address - Street 1:5700 BURNING TREE DR
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79912-4106
Practice Address - Country:US
Practice Address - Phone:915-549-2170
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-05
Last Update Date:2024-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXSA00975363AS0400X
363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical