MEDICARE: MS. TOYIN BRIANA MOSS LVN

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	164X00000X	Licensed Vocational Nurse	224560	TX

General Provider Information

NPI Number	:	1629578349
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. TOYIN BRIANA MOSS LVN

Provider Business Mailing Address
First Line	:	131 DREW AVE
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78220-1016
Country	:	US
Telephone Number	:	210-317-1430
Fax Number	:

Provider Business Practice Location Address
First Line	:	4335 W PIEDRAS DR
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78228-1215
Country	:	US
Telephone Number	:	210-731-9570
Fax Number	:	210-731-9575

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

Provider Enumeration Date	:	02/19/2018
Last Update Date	:	02/19/2018

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