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General NPI Number Information
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NPI Number | 1053201475
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Entity Type | Organization
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Legal Business Name | WAYWARD CARE PROFESSIONAL CORPORATION
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Dates
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Enumeration Date | 07/07/2025
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Last Update Date | 08/01/2025
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Provider Practice Location Address
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Address Line | 301 S FAIR OAKS AVE STE 105
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City | PASADENA
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State | CA
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Zip | 91105-2536
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Country | US
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Telephone | 415-780-1515
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Fax |
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Provider Business Mailing Address
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Address Line | 301 S FAIR OAKS AVE STE 105
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City | PASADENA
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State | CA
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Zip | 91105-2536
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Country | US
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Telephone | 415-780-1515
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Fax |
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. SCOTT MOSSER
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Credential | MD
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Telephone | 415-780-1515
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2086S0122X
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Taxonomy Name | Plastic and Reconstructive Surgery Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 2080A0000X
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Taxonomy Name | Pediatric Adolescent Medicine Physician
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License Number |
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License Number State |
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