Provider Demographics
NPI:1073295010
Name:MOSE, MONIUE CAPRI
Entity Type:Individual
Prefix:
First Name:MONIUE
Middle Name:CAPRI
Last Name:MOSE
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:PO BOX 96
Mailing Address - Street 2:
Mailing Address - City:DAGGETT
Mailing Address - State:CA
Mailing Address - Zip Code:92327-0096
Mailing Address - Country:US
Mailing Address - Phone:424-246-0321
Mailing Address - Fax:
Practice Address - Street 1:35515 NATIONAL TRAILS HWY #3
Practice Address - Street 2:
Practice Address - City:DAGGETT
Practice Address - State:CA
Practice Address - Zip Code:92327
Practice Address - Country:US
Practice Address - Phone:424-246-0321
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-01
Last Update Date:2023-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1-13-13691106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician