Healthcare Provider Details

I. General information

NPI: 1588792048
Provider Name (Legal Business Name): MICHAEL T MOSHER M.D A MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/28/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

415 ROLLING OAKS DR STE 280
THOUSAND OAKS CA
91361-1049
US

IV. Provider business mailing address

415 ROLLING OAKS DR STE 280
THOUSAND OAKS CA
91361-1049
US

V. Phone/Fax

Practice location:
  • Phone: 805-496-8522
  • Fax: 805-496-0469
Mailing address:
  • Phone: 805-496-8522
  • Fax: 805-496-0469

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RA0201X
TaxonomyAllergy & Immunology (Internal Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. MICHAEL THOMAS MOSHER
Title or Position: PRESIDENT
Credential: M.D
Phone: 805-496-8522