Healthcare Provider Details

I. General information

NPI: 1801048079
Provider Name (Legal Business Name): RONALD B MOSS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/18/2008
Last Update Date: 03/28/2026
Certification Date: 03/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

517 HIDDEN RIDGE CT
ENCINITAS CA
92024-5838
US

IV. Provider business mailing address

PO BOX 41
SOLANA BEACH CA
92075-0041
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:
Title or Position:
Credential:
Phone: