Healthcare Provider Details

I. General information

NPI: 1619533072
Provider Name (Legal Business Name): MOSSBRAE MEDICAL GROUP P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2019
Last Update Date: 12/24/2024
Certification Date: 12/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

234 GATEWAY PARK DR
MOUNT SHASTA CA
96067-9236
US

IV. Provider business mailing address

PO BOX 66
MOUNT SHASTA CA
96067-0066
US

V. Phone/Fax

Practice location:
  • Phone: 530-240-4855
  • Fax:
Mailing address:
  • Phone: 530-240-4855
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code364SH0200X
TaxonomyHome Health Clinical Nurse Specialist
License Number
License Number State

VIII. Authorized Official

Name: DR. AARON MICHAEL STUTZ
Title or Position: CHIEF EXECUTIVE OFFICER
Credential: MD
Phone: 530-240-4855