1124158324 NPI number — MANSOOR MOSLEY MD

Table of content: (NPI 1124158324)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1124158324 NPI number — MANSOOR MOSLEY MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MANSOOR MOSLEY MD
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1124158324
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/20/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1220 HEMLOCK WAY STE 104
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SANTA ANA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92707-3651
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
714-754-5400
Provider Business Mailing Address Fax Number:
714-754-6836

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1220 HEMLOCK WAY STE 104
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SANTA ANA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92707-3651
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
714-754-5400
Provider Business Practice Location Address Fax Number:
714-754-6836
Provider Enumeration Date:
03/06/2007

Additional Information

Authorized Official

Authorized Official Last Name:
MOSLEY
Authorized Official First Name:
MANSOOR
Authorized Official Middle Name:
Authorized Official Title or Position:
DOCTOR
Authorized Official Telephone Number:
714-754-5400

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  A41405 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 00A414050 CA , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com