Healthcare Provider Details

I. General information

NPI: 1114836954
Provider Name (Legal Business Name): JAMES MOSHER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/07/2026
Last Update Date: 09/07/2026
Certification Date: 09/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11262 CAMPUS ST
LOMA LINDA CA
92350-1727
US

IV. Provider business mailing address

229 G ST
CHULA VISTA CA
91910-3914
US

V. Phone/Fax

Practice location:
  • Phone: 909-558-4923
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number95229814
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: