MEDICARE: DR. ADELE REGINA MOUSSAS M.D.

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	207Q00000X	Family Medicine Physician	G69924	CA

General Provider Information

NPI Number	:	1811000847
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ADELE REGINA MOUSSAS M.D.

Provider Business Mailing Address
First Line	:	500 JEFFERSON BLVD # B
Second Line	:	# 180
City	:	WEST SACRAMENTO
State	:	CA
Zip	:	95605-2350
Country	:	US
Telephone Number	:	916-403-2900
Fax Number	:	916-403-2999

Provider Business Practice Location Address
First Line	:	500 JEFFERSON BLVD # B
Second Line	:	# 180
City	:	WEST SACRAMENTO
State	:	CA
Zip	:	95605-2350
Country	:	US
Telephone Number	:	916-403-2900
Fax Number	:	916-403-2999

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

Provider Enumeration Date	:	08/16/2006
Last Update Date	:	11/14/2011

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