Healthcare Provider Details

I. General information

NPI: 1558028217
Provider Name (Legal Business Name): GARY LYNN MOSES ND
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/17/2021
Last Update Date: 11/17/2021
Certification Date: 11/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

355 NARA VISA RD NW
LOS RANCHOS NM
87107-6127
US

IV. Provider business mailing address

355 NARA VISA RD NW
LOS RANCHOS NM
87107-6127
US

V. Phone/Fax

Practice location:
  • Phone: 505-344-1557
  • Fax:
Mailing address:
  • Phone: 505-344-1557
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code173C00000X
TaxonomyReflexologist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: