Healthcare Provider Details

I. General information

NPI: 1235871427
Provider Name (Legal Business Name): MICHAEL MOSSAD DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/08/2022
Last Update Date: 12/06/2025
Certification Date: 12/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5525 GROSSMONT CENTER DR
LA MESA CA
91942-3009
US

IV. Provider business mailing address

5525 GROSSMONT CENTER DR
LA MESA CA
91942-3009
US

V. Phone/Fax

Practice location:
  • Phone: 619-740-6000
  • Fax:
Mailing address:
  • Phone: 619-740-6000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number20A24347
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: