Healthcare Provider Details

I. General information

NPI: 1740655935
Provider Name (Legal Business Name): DR. RONALD B MOSS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/14/2015
Last Update Date: 03/25/2026
Certification Date: 03/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

345 SAXONY RD SUITE 105
ENCINITAS CA
92024-2787
US

IV. Provider business mailing address

1931 AVENIDA JOAQUIN
ENCINITAS CA
92024-7108
US

V. Phone/Fax

Practice location:
  • Phone: 760-436-6404
  • Fax: 760-462-3986
Mailing address:
  • Phone: 619-742-6035
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License NumberG79340
License Number StateCA

VIII. Authorized Official

Name: RONALD B MOSS
Title or Position: CEO
Credential: M.D.
Phone: 619-742-6035