Provider Demographics
NPI:1457243040
Name:MAZZAGATTE, GRACE (PA-S)
Entity type:Individual
Prefix:
First Name:GRACE
Middle Name:
Last Name:MAZZAGATTE
Suffix:
Gender:F
Credentials:PA-S
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Other - Credentials:
Mailing Address - Street 1:3770 BOYD AVE APT 163
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92111-4169
Mailing Address - Country:US
Mailing Address - Phone:858-248-3401
Mailing Address - Fax:
Practice Address - Street 1:9055 BALBOA AVE
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123-1509
Practice Address - Country:US
Practice Address - Phone:619-849-3331
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-17
Last Update Date:2025-07-17
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant