MEDICARE: SAMUEL MOSES MD

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	2085R0202X	Diagnostic Radiology Physician	2009-0106	NM
2	2085R0202X	Diagnostic Radiology Physician	C36173	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	00C361730	OTHER	CA	BLUE SHIELD

General Provider Information

NPI Number	:	1194764779
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SAMUEL MOSES MD

Provider Business Mailing Address
First Line	:	26859 PINE HOLLOW CT
Second Line	:
City	:	VALENCIA
State	:	CA
Zip	:	91381-0615
Country	:	US
Telephone Number	:	661-253-2231
Fax Number	:

Provider Business Practice Location Address
First Line	:	26859 PINE HOLLOW CT
Second Line	:
City	:	VALENCIA
State	:	CA
Zip	:	91381-0615
Country	:	US
Telephone Number	:	661-253-2231
Fax Number	:

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

Provider Enumeration Date	:	06/06/2006
Last Update Date	:	11/02/2011

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