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NPI Code Detail

MEDICARE: SHOSHANA MOED

MEDICARE: SHOSHANA MOED
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
1390200000XStudent in an Organized Health Care Education/Training Program

General Provider Information

NPI Number : 1346062072
Entity Type Code : Individual
Provider Name (Legal Business Name) : SHOSHANA MOED
Provider Business Mailing Address
First Line : 2526 MARTIN LUTHER KING JR WAY
Second Line :
City : BERKELEY
State : CA
Zip : 94704-2607
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 2526 MARTIN LUTHER KING JR WAY
Second Line :
City : BERKELEY
State : CA
Zip : 94704-2607
Country : US
Telephone Number : 510-467-0520
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/24/2024
Last Update Date : 10/24/2024

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Directions to “ SHOSHANA MOED ” Practice Location

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