Healthcare Provider Details

I. General information

NPI: 1285858043
Provider Name (Legal Business Name): RONALD E MOSER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/12/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30260 RANCHO VIEJO RD
SAN JUAN CAPISTRANO CA
92675-1561
US

IV. Provider business mailing address

30260 RANCHO VIEJO RD
SAN JUAN CAPISTRANO CA
92675-1561
US

V. Phone/Fax

Practice location:
  • Phone: 949-661-1700
  • Fax: 949-661-4913
Mailing address:
  • Phone: 949-661-1700
  • Fax: 949-661-4913

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License NumberG56492
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: