Healthcare Provider Details

I. General information

NPI: 1780244418
Provider Name (Legal Business Name): DANIEL MOSCOSO ESPIRITU
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/14/2019
Last Update Date: 06/14/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1575 7TH AVE
SAN FRANCISCO CA
94122-3704
US

IV. Provider business mailing address

1699 19TH AVE
SAN FRANCISCO CA
94122-4517
US

V. Phone/Fax

Practice location:
  • Phone: 415-566-1200
  • Fax:
Mailing address:
  • Phone: 818-300-9338
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number10109
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: