Provider Demographics
NPI:1699873406
Name:MOSCA, DEBORAH EILEEN (DC)
Entity type:Individual
Prefix:
First Name:DEBORAH
Middle Name:EILEEN
Last Name:MOSCA
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:DEBORAH
Other - Middle Name:EILEEN
Other - Last Name:MOSCA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:851 FREMONT AVE
Mailing Address - Street 2:STE 111
Mailing Address - City:LOS ALTOS
Mailing Address - State:CA
Mailing Address - Zip Code:94024-5602
Mailing Address - Country:US
Mailing Address - Phone:650-917-2030
Mailing Address - Fax:650-917-2034
Practice Address - Street 1:851 FREMONT AVE
Practice Address - Street 2:STE 111
Practice Address - City:LOS ALTOS
Practice Address - State:CA
Practice Address - Zip Code:94024-5602
Practice Address - Country:US
Practice Address - Phone:650-917-2030
Practice Address - Fax:650-917-2034
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2017-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA19924111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
T90985Medicare UPIN
CADC0199240Medicare PIN