Healthcare Provider Details

I. General information

NPI: 1710998919
Provider Name (Legal Business Name): ANDREA MOSKOWITZ MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/11/2006
Last Update Date: 09/30/2024
Certification Date: 09/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11303 W WASHINGTON BLVD STE 200
LOS ANGELES CA
90066-6003
US

IV. Provider business mailing address

11303 W WASHINGTON BLVD STE 200
LOS ANGELES CA
90066-6003
US

V. Phone/Fax

Practice location:
  • Phone: 310-482-3200
  • Fax: 310-915-8579
Mailing address:
  • Phone: 323-482-3200
  • Fax: 310-915-8579

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberG66840
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberG66840
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: