Provider Demographics
NPI:1285790212
Name:MOSSUTO, MARK (DC)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:
Last Name:MOSSUTO
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
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Mailing Address - Street 1:7540 METROPOLITAN DR
Mailing Address - Street 2:SUITE 109
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92108-4499
Mailing Address - Country:US
Mailing Address - Phone:619-294-9342
Mailing Address - Fax:619-294-9365
Practice Address - Street 1:7540 METROPOLITAN DR
Practice Address - Street 2:SUITE 109
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-4499
Practice Address - Country:US
Practice Address - Phone:619-294-9342
Practice Address - Fax:619-294-9365
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-27
Last Update Date:2008-02-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CADC23070111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor