Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101Y00000X | Counselor | 0136691 | NM |
Y | 101YP1600X | Pastoral Counselor | 0136691 | NM |
NPI | 1114369824 |
---|---|
Provider Name | Mr. George C. Moscona |
First Address | Rio Communities, NM 87002-7230 |
Second Address | Rio Communities, NM 87002-7230 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/07/2013 |
Last Update Date | 23/07/2013 |