Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | 007132 | AZ |
NPI | 1023372950 |
---|---|
Provider Name | Dr. Christine R Moussa |
First Address | Tuscon, AZ 85712-1337 |
Second Address | Tuscon, AZ 85712-1337 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/06/2012 |
Last Update Date | 15/09/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
405518 | (05) | AZ |