MEDICARE: HAYAT MOUSA MD

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	2080P0206X	Pediatric Gastroenterology Physician	35065608	OH
2	2080P0206X	Pediatric Gastroenterology Physician	C 137969	CA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
4	MO0890502	OTHER	OH	MEDICARE

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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1821083338
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HAYAT MOUSA MD

Provider Business Mailing Address
First Line	:	3020 CHILDRENS WAY
Second Line	:	MC5003
City	:	SAN DIEGO
State	:	CA
Zip	:	92123-4223
Country	:	US
Telephone Number	:	858-309-6300
Fax Number	:

Provider Business Practice Location Address
First Line	:	8110 BIRMINGHAM WAY
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92123-2758
Country	:	US
Telephone Number	:	858-966-4003
Fax Number	:

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

Provider Enumeration Date	:	09/12/2005
Last Update Date	:	05/03/2017

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Directions to “ HAYAT MOUSA MD” Practice Location

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