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General NPI Number Information
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NPI Number | 1801254222
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Entity Type | Individual
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Provider Name | LARISSA MOZES
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Gender | Female
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Dates
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Enumeration Date | 01/29/2016
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Last Update Date | 11/08/2024
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Provider Practice Location Address
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Address Line | 23201 MILL CREEK DR STE 221
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City | LAGUNA HILLS
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State | CA
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Zip | 92653-7906
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Country | US
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Telephone | 818-350-3264
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Fax |
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Provider Business Mailing Address
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Address Line | 18756 ERWIN ST
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City | TARZANA
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State | CA
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Zip | 91335-6825
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Country | US
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Telephone | 818-350-3264
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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 | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 111343
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License Number State | CA
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