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NPI Code Detail

MEDICARE: DIANE CARROL MOSES SUDRC 2

MEDICARE: DIANE CARROL MOSES SUDRC 2
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
1101YA0400XAddiction (Substance Use Disorder) CounselorCA

General Provider Information

NPI Number : 1558298547
Entity Type Code : Individual
Provider Name (Legal Business Name) : DIANE CARROL MOSES SUDRC 2
Provider Business Mailing Address
First Line : 10740 JASPER AVE
Second Line :
City : REDLANDS
State : CA
Zip : 92374-7680
Country : US
Telephone Number : 909-747-8962
Fax Number :
Provider Business Practice Location Address
First Line : 11646 ENCANTO LN
Second Line :
City : COLTON
State : CA
Zip : 92324-9218
Country : US
Telephone Number : 909-747-8962
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/05/2026
Last Update Date : 05/05/2026

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Directions to “ DIANE CARROL MOSES SUDRC 2” Practice Location

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