Provider Demographics
NPI:1891534681
Name:MOSES, CALISTA ISATU MARIE
Entity type:Individual
Prefix:
First Name:CALISTA
Middle Name:ISATU MARIE
Last Name:MOSES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1642 RANCH HOUSE
Mailing Address - Street 2:
Mailing Address - City:NEW BRAUNFELS
Mailing Address - State:TX
Mailing Address - Zip Code:78132-3491
Mailing Address - Country:US
Mailing Address - Phone:956-540-1160
Mailing Address - Fax:
Practice Address - Street 1:1642 RANCH HOUSE
Practice Address - Street 2:
Practice Address - City:NEW BRAUNFELS
Practice Address - State:TX
Practice Address - Zip Code:78132-3491
Practice Address - Country:US
Practice Address - Phone:956-540-1160
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-21
Last Update Date:2024-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program