Healthcare Provider Details

I. General information

NPI: 1548172158
Provider Name (Legal Business Name): RANDY MOSLEY
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/18/2026
Last Update Date: 09/18/2026
Certification Date: 09/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2363 S KENNEDY LN STE 7
YUMA AZ
85365-2416
US

IV. Provider business mailing address

1140 S 20TH AVE
YUMA AZ
85364-3511
US

V. Phone/Fax

Practice location:
  • Phone: 928-246-5313
  • Fax:
Mailing address:
  • Phone: 928-246-5313
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: