MEDICARE: CRAIG CZELUSTA PA-C

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	0110004661	VA
2	363AM0700X	Medical Physician Assistant	PA10327	TX

General Provider Information

NPI Number	:	1457767527
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CRAIG CZELUSTA PA-C

Provider Business Mailing Address
First Line	:	649 RIVERSIDE DR
Second Line	:
City	:	NEW BRAUNFELS
State	:	TX
Zip	:	78130-3635
Country	:	US
Telephone Number	:	210-262-3182
Fax Number	:

Provider Business Practice Location Address
First Line	:	1761 HIGHWAY 46 W # 104
Second Line	:
City	:	NEW BRAUNFELS
State	:	TX
Zip	:	78132-4750
Country	:	US
Telephone Number	:	830-433-7816
Fax Number	:

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

Provider Enumeration Date	:	07/09/2014
Last Update Date	:	11/13/2024

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