=====================================================
General NPI Number Information
=====================================================
NPI Number | 1285858043
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | RONALD E MOSER M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/12/2007
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 30260 RANCHO VIEJO RD
-----------------------------------------------------
City | SAN JUAN CAPISTRANO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92675-1561
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 949-661-1700
-----------------------------------------------------
Fax | 949-661-4913
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 30260 RANCHO VIEJO RD
-----------------------------------------------------
City | SAN JUAN CAPISTRANO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92675-1561
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 949-661-1700
-----------------------------------------------------
Fax | 949-661-4913
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2086S0122X
-----------------------------------------------------
Taxonomy Name | Plastic and Reconstructive Surgery Physician
-----------------------------------------------------
License Number | G56492
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------