Healthcare Provider Details

I. General information

NPI: 1285050815
Provider Name (Legal Business Name): LUCIUS LEE MOSLEY III
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/06/2014
Last Update Date: 03/06/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

721 8TH ST
BAKERSFIELD CA
93304-2224
US

IV. Provider business mailing address

721 8TH ST
BAKERSFIELD CA
93304-2224
US

V. Phone/Fax

Practice location:
  • Phone: 661-326-9700
  • Fax: 661-326-9709
Mailing address:
  • Phone: 661-326-9709
  • Fax: 661-326-9709

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: