Healthcare Provider Details

I. General information

NPI: 1487174595
Provider Name (Legal Business Name): SARAH ELIZABETH MOSES LVN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/21/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12625 HESPERIA RD VICTOR VALLEY BEHAVIORAL HEALTH CENTER
VICTORVILLE CA
92395
US

IV. Provider business mailing address

12625 HESPERIA RD VICTOR VALLEY BEHAVIORAL HEALTH CENTER
VICTORVILLE CA
92395
US

V. Phone/Fax

Practice location:
  • Phone: 760-995-8300
  • Fax:
Mailing address:
  • Phone: 760-995-8300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License Number29287
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: