MEDICARE: MOSSPARK ASSOCIATES INC

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	335E00000X	Prosthetic/Orthotic Supplier
2	332B00000X	Durable Medical Equipment & Medical Supplies

General Provider Information

NPI Number	:	1376712224
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MOSSPARK ASSOCIATES INC

Provider Business Mailing Address
First Line	:	19115 GREEN FOREST RD
Second Line	:
City	:	LOS GATOS
State	:	CA
Zip	:	95033-7807
Country	:	US
Telephone Number	:	408-335-8744
Fax Number	:

Provider Business Practice Location Address
First Line	:	1664 ALUM ROCK AVE
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95116-2437
Country	:	US
Telephone Number	:	408-335-8744
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MS. LOLITA LYDIA SHARP
Credential	:
Telephone Number	:	408-335-8744

Provider Enumeration Date	:	02/25/2008
Last Update Date	:	02/25/2008

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