Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | G48717 | CA |
N | 2080A0000X | Adolescent Medicine | G48717 | CA |
NPI | 1154351674 |
---|---|
Provider Name | Dr. Anna Barbara Moscicki |
First Address | Los Angeles, CA 90045-5631 |
Second Address | San Francisco, CA 94143 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/07/2006 |
Last Update Date | 23/12/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00G487170 | (05) | CA |
A89884 | (02) | CA |