MEDICARE: CIARRA MOSBY

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	175T00000X	Peer Specialist

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1376241596
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CIARRA MOSBY

Provider Business Mailing Address
First Line	:	4304 OCEAN VIEW BLVD
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92113-1916
Country	:	US
Telephone Number	:	619-823-6508
Fax Number	:

Provider Business Practice Location Address
First Line	:	4304 OCEAN VIEW BLVD
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92113-1916
Country	:	US
Telephone Number	:	619-823-6508
Fax Number	:

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

Provider Enumeration Date	:	02/16/2023
Last Update Date	:	03/06/2023

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Directions to “ CIARRA MOSBY ” Practice Location

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