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General NPI Number Information
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NPI Number | 1124158324
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Entity Type | Organization
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Legal Business Name | MANSOOR MOSLEY MD
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Dates
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Enumeration Date | 03/06/2007
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Last Update Date | 11/20/2012
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Provider Practice Location Address
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Address Line | 1220 HEMLOCK WAY STE 104
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City | SANTA ANA
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State | CA
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Zip | 92707-3651
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Country | US
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Telephone | 714-754-5400
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Fax | 714-754-6836
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Provider Business Mailing Address
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Address Line | 1220 HEMLOCK WAY STE 104
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City | SANTA ANA
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State | CA
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Zip | 92707-3651
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Country | US
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Telephone | 714-754-5400
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Fax | 714-754-6836
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Authorized Official
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Title or Position | DOCTOR
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Name | DR. MANSOOR MOSLEY
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Credential | MD
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Telephone | 714-754-5400
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | A41405
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License Number State | CA
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