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NPI Code Detail

MEDICARE: ELIJAH RENE MAZUCA LMSW

MEDICARE: ELIJAH RENE MAZUCA LMSW
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
1104100000XSocial Worker113336TX

General Provider Information

NPI Number : 1437080025
Entity Type Code : Individual
Provider Name (Legal Business Name) : ELIJAH RENE MAZUCA LMSW
Provider Business Mailing Address
First Line : 7901 METROPOLIS DR
Second Line :
City : AUSTIN
State : TX
Zip : 78744-3111
Country : US
Telephone Number : 800-423-2111
Fax Number :
Provider Business Practice Location Address
First Line : 7901 METROPOLIS DR
Second Line :
City : AUSTIN
State : TX
Zip : 78744-3111
Country : US
Telephone Number : 800-423-2111
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/25/2026
Last Update Date : 05/25/2026

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Directions to “ ELIJAH RENE MAZUCA LMSW” Practice Location

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