Healthcare Provider Details

I. General information

NPI: 1902117070
Provider Name (Legal Business Name): HOWARD BARRY MOSS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/23/2010
Last Update Date: 04/22/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2139 CAMINITO TIBURON
LA JOLLA CA
92037-7237
US

IV. Provider business mailing address

2139 CAMINITO TIBURON
LA JOLLA CA
92037-7237
US

V. Phone/Fax

Practice location:
  • Phone: 301-357-0797
  • Fax:
Mailing address:
  • Phone: 301-357-0797
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberD0030018
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code2084P0802X
TaxonomyAddiction Psychiatry Physician
License NumberD0030018
License Number StateMD
# 3
Primary TaxonomyN
Taxonomy Code2084P0802X
TaxonomyAddiction Psychiatry Physician
License NumberG36052
License Number StateCA
# 4
Primary TaxonomyY
Taxonomy Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License NumberG36052
License Number StateCA
# 5
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberG36052
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: