Provider Demographics
NPI:1730165630
Name:MOSES, ANDREA BOZZO (MD)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:BOZZO
Last Name:MOSES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ANDREA
Other - Middle Name:
Other - Last Name:MAINMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2011 PINTO LN STE 200
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89106-4007
Mailing Address - Country:US
Mailing Address - Phone:702-664-8279
Mailing Address - Fax:702-382-3575
Practice Address - Street 1:2011 PINTO LN STE 200
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89106-4007
Practice Address - Country:US
Practice Address - Phone:702-664-8279
Practice Address - Fax:702-382-3575
Is Sole Proprietor?:No
Enumeration Date:2005-12-22
Last Update Date:2024-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV17831207V00000X, 207V00000X
AZ34530207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV17831OtherSTATE LICENSE