Healthcare Provider Details

I. General information

NPI: 1053201475
Provider Name (Legal Business Name): WAYWARD CARE PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/07/2025
Last Update Date: 08/01/2025
Certification Date: 07/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 S FAIR OAKS AVE STE 105
PASADENA CA
91105-2536
US

IV. Provider business mailing address

301 S FAIR OAKS AVE STE 105
PASADENA CA
91105-2536
US

V. Phone/Fax

Practice location:
  • Phone: 415-780-1515
  • Fax:
Mailing address:
  • Phone: 415-780-1515
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. SCOTT MOSSER
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 415-780-1515