Healthcare Provider Details

I. General information

NPI: 1194522318
Provider Name (Legal Business Name): MAZARINE TSUJI PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/26/2025
Last Update Date: 03/05/2025
Certification Date: 03/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 N 10TH AVE STE 200
STAYTON OR
97383-1487
US

IV. Provider business mailing address

1401 N 10TH AVE STE 200
STAYTON OR
97383-1487
US

V. Phone/Fax

Practice location:
  • Phone: 503-769-7151
  • Fax:
Mailing address:
  • Phone: 503-769-7151
  • Fax: 503-769-9316

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA224289
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: