Healthcare Provider Details

I. General information

NPI: 1285974162
Provider Name (Legal Business Name): BRET A. MOSHER L.AC., O.M.D., D.N.B
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/28/2013
Last Update Date: 02/28/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13364 POWAY RD
POWAY CA
92064-4626
US

IV. Provider business mailing address

13364 POWAY RD
POWAY CA
92064-4626
US

V. Phone/Fax

Practice location:
  • Phone: 858-679-2995
  • Fax:
Mailing address:
  • Phone: 858-679-2995
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC 3428
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: