Provider Demographics
NPI:1285605600
Name:MOSHREF, WEISS M (PA)
Entity type:Individual
Prefix:
First Name:WEISS
Middle Name:M
Last Name:MOSHREF
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2601 OSWELL ST
Mailing Address - Street 2:STE101
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93306-3156
Mailing Address - Country:US
Mailing Address - Phone:661-872-9999
Mailing Address - Fax:661-616-5748
Practice Address - Street 1:2601 OSWELL STREET
Practice Address - Street 2:SUITE101
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93306-3156
Practice Address - Country:US
Practice Address - Phone:661-872-9999
Practice Address - Fax:661-616-5748
Is Sole Proprietor?:No
Enumeration Date:2006-02-01
Last Update Date:2012-02-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAPA18322363AM0700X, 363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1053345991Medicaid
CAZZZ41991ZMedicare PIN
CAQ64444Medicare UPIN