Healthcare Provider Details

I. General information

NPI: 1306777131
Provider Name (Legal Business Name): MICHAEL ANTHONY MAZZUCA RN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/28/2026
Last Update Date: 05/28/2026
Certification Date: 05/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

795 WILLOW RD BLDG 351
MENLO PARK CA
94025-2539
US

IV. Provider business mailing address

795 WILLOW RD BLDG 351
MENLO PARK CA
94025-2539
US

V. Phone/Fax

Practice location:
  • Phone: 650-493-5000
  • Fax:
Mailing address:
  • Phone: 650-493-5000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number778414
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: