MEDICARE: MAIA ALEXANDRA MOSSE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	A186230	CA

General Provider Information

NPI Number	:	1154940187
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MAIA ALEXANDRA MOSSE

Provider Business Mailing Address
First Line	:	2979 WOODSIDE RD
Second Line	:
City	:	WOODSIDE
State	:	CA
Zip	:	94062-2443
Country	:	US
Telephone Number	:	650-851-4747
Fax Number	:

Provider Business Practice Location Address
First Line	:	2979 WOODSIDE RD
Second Line	:
City	:	WOODSIDE
State	:	CA
Zip	:	94062-2443
Country	:	US
Telephone Number	:	650-851-4747
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/09/2020
Last Update Date	:	10/31/2025

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