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General NPI Number Information
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NPI Number | 1760251383
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Entity Type | Individual
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Provider Name | ALICIA MOEZ WAYLAND FNP-BC
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Gender | Female
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Dates
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Enumeration Date | 12/22/2023
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Last Update Date | 12/22/2023
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Provider Practice Location Address
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Address Line | 777 KNOWLES DR STE 16
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City | LOS GATOS
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State | CA
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Zip | 95032-1448
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Country | US
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Telephone | 408-374-1320
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Fax |
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Provider Business Mailing Address
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Address Line | 1720 SW 4TH AVE APT 1609
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City | PORTLAND
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State | OR
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Zip | 97201-5561
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Country | US
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Telephone | 808-765-8204
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 95028442
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License Number State | CA
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