Healthcare Provider Details

I. General information

NPI: 1114910551
Provider Name (Legal Business Name): NANCY BROITMAN MOZELSIO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2005
Last Update Date: 11/22/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 LA CASA VIA BLDG 2, #209
WALNUT CREEK CA
94598-3045
US

IV. Provider business mailing address

130 LA CASA VIA BLDG 2, #209
WALNUT CREEK CA
94598-3045
US

V. Phone/Fax

Practice location:
  • Phone: 925-935-6252
  • Fax: 925-930-0942
Mailing address:
  • Phone: 925-935-6252
  • Fax: 925-930-0942

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License NumberA75031
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: