Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207KA0200X | Allergist | A62252 | CA |
NPI | 1053417865 |
---|---|
Provider Name | Michael T Mosher |
First Address | Thousand Oaks, CA 91361-1029 |
Second Address | Thousand Oaks, CA 91361-1029 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/09/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
H69203 | (02) | CA |