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NPI Code Detail

MEDICARE: MRS. IVETTE SUSAN MOSES PT

MEDICARE: MRS. IVETTE SUSAN MOSES PT
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
1225100000XPhysical TherapistPT 19565CA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1PT 19565OTHERCAPT LICENSE

General Provider Information

NPI Number : 1669572426
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. IVETTE SUSAN MOSES PT
Provider Business Mailing Address
First Line : 201 SANDPOINTE AVE
Second Line : SUITE 130
City : SANTA ANA
State : CA
Zip : 92707-5778
Country : US
Telephone Number : 714-557-9292
Fax Number : 714-557-9137
Provider Business Practice Location Address
First Line : 201 SANDPOINTE AVE
Second Line : SUITE 130
City : SANTA ANA
State : CA
Zip : 92707-5778
Country : US
Telephone Number : 714-557-9292
Fax Number : 714-557-9137
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/22/2006
Last Update Date : 01/22/2008

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