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NPI Code Detail

MEDICARE: JUAN MIGUEL MAZARA

MEDICARE: JUAN MIGUEL MAZARA
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
1363A00000XPhysician Assistant

General Provider Information

NPI Number : 1467113977
Entity Type Code : Individual
Provider Name (Legal Business Name) : JUAN MIGUEL MAZARA
Provider Business Mailing Address
First Line : 1260 ELM ST
Second Line :
City : MANCHESTER
State : NH
Zip : 03101-1305
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1260 ELM ST
Second Line :
City : MANCHESTER
State : NH
Zip : 03101-1305
Country : US
Telephone Number : 978-387-6881
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/06/2022
Last Update Date : 01/06/2022

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Directions to “ JUAN MIGUEL MAZARA ” Practice Location

Language Start Address Practice Location
These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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