Provider Demographics
NPI:1861539348
Name:MOSER, NORMAN K (PA-C)
Entity type:Individual
Prefix:
First Name:NORMAN
Middle Name:K
Last Name:MOSER
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1464 APPALACHIAN PL
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91915-1556
Mailing Address - Country:US
Mailing Address - Phone:619-370-1247
Mailing Address - Fax:619-532-8457
Practice Address - Street 1:34800 BOB WILSON DR SUITE 112
Practice Address - Street 2:NMCSD
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92134-1112
Practice Address - Country:US
Practice Address - Phone:619-532-8421
Practice Address - Fax:619-532-8457
Is Sole Proprietor?:No
Enumeration Date:2007-01-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCCPA# 1027619363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
1027619OtherNCCPA