MEDICARE: PETER M. MAZZARESE P.A.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	PA16565	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1124099387
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PETER M. MAZZARESE P.A.

Provider Business Mailing Address
First Line	:	5555 RESERVOIR DR STE 203
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92120-5115
Country	:	US
Telephone Number	:	619-229-3340
Fax Number	:	619-229-3341

Provider Business Practice Location Address
First Line	:	5555 RESERVOIR DR STE 203
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92120-5115
Country	:	US
Telephone Number	:	619-229-3340
Fax Number	:	619-229-3341

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/27/2006
Last Update Date	:	12/13/2021

Similar Medicare Providers

1881914000 — GRUPO MEDICO POLICLINICA SAN PEDRO MEDICARE ADVANTAGE
Practice Location Address:

211 CALLE MORSE
ARROYO, PR
00714-2350

Practice Phone: 787-839-3980
Practice Fax: 787-271-2515

1073675591 — MICHAEL G SANTOMAURO M.D
Practice Location Address:

5555 RESERVOIR DR STE 203
SAN DIEGO, CA
92120-5115

Practice Phone: 619-326-2626
Practice Fax:

1669880324 — MANMADHA CHERISHMA JAMI
Practice Location Address:

12418 CREEKVIEW DR
SAN DIEGO, CA
92128-5115

Practice Phone: 858-603-5922
Practice Fax:

1639026594 — CLEARMIND CLINIC, INC.
Practice Location Address:

1700 N WATERMAN AVE
SAN BERNARDINO, CA
92404-5115

Practice Phone: 510-329-0837
Practice Fax:

1225039431 — DR. ALWIN L. TORRES-ORTIZ MD
Practice Location Address:

702 CALLE CIPRES
SAN JUAN, PR
00924-5115

Practice Phone: 787-764-7714
Practice Fax: 787-764-7714

1639143530 — CARINA D BUHAY MD
Practice Location Address:

1700 N WATERMAN AVE
SAN BERNARDINO, CA
92404-5115

Practice Phone: 909-883-8611
Practice Fax:

Directions to “ PETER M. MAZZARESE P.A.” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.