MEDICARE: DR. ANNIE MOOSER 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	2086S0129X	Vascular Surgery Physician	78692	AZ
2	2086S0129X	Vascular Surgery Physician	A174697	CA
3	208600000X	Surgery Physician	A174697	CA

General Provider Information

NPI Number	:	1942629340
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANNIE MOOSER MD

Provider Business Mailing Address
First Line	:	34800 BOB WILSON DR
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92134-1098
Country	:	US
Telephone Number	:	619-532-6400
Fax Number	:

Provider Business Practice Location Address
First Line	:	3400 BOB WILSON DR
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92134-0001
Country	:	US
Telephone Number	:	619-532-6400
Fax Number	:

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

Provider Enumeration Date	:	04/14/2014
Last Update Date	:	04/07/2026

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Directions to “ DR. ANNIE MOOSER MD” Practice Location

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