Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2100X | Nurse Practitioner - Acute Care | 95001181 | CA |
NPI | 1013261973 |
---|---|
Provider Name | George J Moussally |
First Address | Visalia, CA 93279-0728 |
Second Address | Visalia, CA 93291-6237 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/10/2012 |
Last Update Date | 01/06/2016 |