Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Jack Mazzulo, MD

Individual provider Emergency Medicine Physician · NPI 1518511690

Jack Mazzulo, MD is an Emergency Medicine in Los Angeles, California. Graduated from Oregon Health & Sciences Univ School of Dentistry in 2021, 5 years ago. Practices with Southern California Emergency Medical Group, a 25-clinician group and accepts Medicare assignment. Licensed in California.

Years since qualifying
5
Trained at
Oregon Health & Sciences Univ School of Dentistry
Licensed in
CA
In the registry since
2019
What do these letters mean?
MD — Doctor of Medicine
A physician who completed allopathic medical school.

See every abbreviation used in this directory →

Claim this listing Report a problem Suggest an edit

Practice location Address checks out

1200 N State St
Los Angeles, CA 90089-1001
Phone: (704) 517-4334
Show map & directions

Directions in Google Maps · Apple Maps · OpenStreetMap

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Emergency Medicine Physician (primary) Taxonomy 207P00000X · Licence A197603 (CA)

Record details

NPI number1518511690
Entity typeIndividual (Type 1)
GenderMale
Credentials MD
Sole proprietorNo
NPI enumeratedJuly 28, 2019
Last updated in NPPESJuly 15, 2025
Certification dateJuly 15, 2025

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyEMERGENCY MEDICINE
Medical schoolOREGON HEALTH & SCIENCES UNIV SCHOOL OF DENTISTRY
Graduated 2021 (5 years in practice)
Group practice Southern California Emergency Medical Group — 25 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations2 on file with Medicare

Other providers in Los Angeles