Healthcare Provider Details

I. General information

NPI: 1235957820
Provider Name (Legal Business Name): DEBRA MOSELEY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/01/2024
Last Update Date: 03/31/2025
Certification Date: 03/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PO BOX 2632
LAKE ISABELLA CA
93240-2632
US

IV. Provider business mailing address

PO BOX 1167
WOFFORD HTS CA
93285-1167
US

V. Phone/Fax

Practice location:
  • Phone: 760-379-3412
  • Fax:
Mailing address:
  • Phone: 818-723-6080
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code373H00000X
TaxonomyDay Training/Habilitation Specialist
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: