Provider Demographics
NPI:1427786276
Name:MERLUZA, MA HAZELENE (PA-C)
Entity type:Individual
Prefix:
First Name:MA HAZELENE
Middle Name:
Last Name:MERLUZA
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:HAZELENE
Other - Middle Name:
Other - Last Name:MERLUZA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PA-C
Mailing Address - Street 1:3749 BETTMAN WAY
Mailing Address - Street 2:
Mailing Address - City:SOUTH SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94080-5204
Mailing Address - Country:US
Mailing Address - Phone:650-580-5486
Mailing Address - Fax:
Practice Address - Street 1:3749 BETTMAN WAY
Practice Address - Street 2:
Practice Address - City:SOUTH SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94080-5204
Practice Address - Country:US
Practice Address - Phone:650-580-5486
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-10
Last Update Date:2022-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant