Healthcare Provider Details

I. General information

NPI: 1114369824
Provider Name (Legal Business Name): GEORGE C. MOSCONA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/23/2013
Last Update Date: 12/30/2025
Certification Date: 12/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

604 W ORGAN AVE
LAS CRUCES NM
88005-2626
US

IV. Provider business mailing address

604 W ORGAN AVE
LAS CRUCES NM
88005-2626
US

V. Phone/Fax

Practice location:
  • Phone: 505-453-4169
  • Fax:
Mailing address:
  • Phone: 505-453-4169
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License Number0136691
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number0136691
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: