Provider Demographics
NPI:1154344653
Name:MOSCHELLA, JOANN ELIZABETH (DO)
Entity type:Individual
Prefix:
First Name:JOANN
Middle Name:ELIZABETH
Last Name:MOSCHELLA
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:559 E ALISAL ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:SALINAS
Mailing Address - State:CA
Mailing Address - Zip Code:93905-2516
Mailing Address - Country:US
Mailing Address - Phone:831-769-1304
Mailing Address - Fax:831-757-0291
Practice Address - Street 1:1150 FREMONT BLVD
Practice Address - Street 2:
Practice Address - City:SEASIDE
Practice Address - State:CA
Practice Address - Zip Code:93955-5715
Practice Address - Country:US
Practice Address - Phone:831-899-8100
Practice Address - Fax:831-899-8105
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2011-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A8733207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA94-6000524OtherCOUNTY OF MONTEREY EIN
CAZZZ15686ZMedicare ID - Type UnspecifiedCOUNTY OF MONTEREY GROUP
CA94-6000524OtherCOUNTY OF MONTEREY EIN