Healthcare Provider Details

I. General information

NPI: 1235449117
Provider Name (Legal Business Name): KATYA DIVINSKY MOSELY L.AC.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/13/2010
Last Update Date: 10/13/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3672 WATSEKA AVE #5
LOS ANGELES CA
90034-3931
US

IV. Provider business mailing address

2001 S BARRINGTON AVE SUITE #220
LOS ANGELES CA
90025-5363
US

V. Phone/Fax

Practice location:
  • Phone: 310-630-9836
  • Fax:
Mailing address:
  • Phone: 310-473-7474
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number13895
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: