Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YX0007X | Plastic Surgeon (Head & Neck) | G86605 | CA |
NPI | 1710046396 |
---|---|
Provider Name | Juan Francisco Moscoso |
First Address | Pasadena, CA 91188-0001 |
Second Address | Panorama City, CA 91402-5423 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/12/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00G866050 | (05) | CA |
E98139 | (02) |