Healthcare Provider Details

I. General information

NPI: 1083615983
Provider Name (Legal Business Name): CHARLES A MOSER PH.D., M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/02/2005
Last Update Date: 08/28/2020
Certification Date: 08/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45 CASTRO ST
SAN FRANCISCO CA
94114-1010
US

IV. Provider business mailing address

325 DISTEL CIR
LOS ALTOS CA
94022-1408
US

V. Phone/Fax

Practice location:
  • Phone: 415-600-4900
  • Fax: 415-369-1365
Mailing address:
  • Phone: 415-600-4900
  • Fax: 415-369-1365

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberG75487
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: