MEDICARE: HUMBERTO MOCHIZUKI M.D

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	207RC0000X	Cardiovascular Disease Physician	278003	MA
2	207R00000X	Internal Medicine Physician	64231-20	WI
3	208D00000X	General Practice Physician	125.060774	IL

General Provider Information

NPI Number	:	1417212556
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HUMBERTO MOCHIZUKI M.D

Provider Business Mailing Address
First Line	:	25 MARSTON ST STE 202
Second Line	:
City	:	LAWRENCE
State	:	MA
Zip	:	01841-2357
Country	:	US
Telephone Number	:	978-712-1540
Fax Number	:

Provider Business Practice Location Address
First Line	:	41 MALL RD
Second Line	:
City	:	BURLINGTON
State	:	MA
Zip	:	01805-0001
Country	:	US
Telephone Number	:	781-744-8000
Fax Number	:

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

Provider Enumeration Date	:	07/04/2012
Last Update Date	:	03/03/2026

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