MEDICARE: LISA MOSS

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	106H00000X	Marriage & Family Therapist	MFC 48299	CA

General Provider Information

NPI Number	:	1518081538
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LISA MOSS

Provider Business Mailing Address
First Line	:	12129 EASTBOURNE RD
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92128-3717
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	9330 CARMEL MOUNTAIN RD
Second Line	:	SUITE C
City	:	SAN DIEGO
State	:	CA
Zip	:	92129-2157
Country	:	US
Telephone Number	:	858-212-2295
Fax Number	:

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

Provider Enumeration Date	:	03/16/2007
Last Update Date	:	11/02/2010

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