MEDICARE: MS. MICHELE MOZELSIO P.A.

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	363AM0700X	Medical Physician Assistant	PA17712	CA

General Provider Information

NPI Number	:	1750302204
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MICHELE MOZELSIO P.A.

Provider Business Mailing Address
First Line	:	1426 WALLER ST APT 6
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94117-2954
Country	:	US
Telephone Number	:	415-863-4048
Fax Number	:

Provider Business Practice Location Address
First Line	:	50 LECH WALESA
Second Line	:	TOM WADDELL HEALTH CENTER
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94102-4506
Country	:	US
Telephone Number	:	415-355-7400
Fax Number	:	415-355-7402

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

Provider Enumeration Date	:	07/21/2006
Last Update Date	:	07/08/2007

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