Provider Demographics
NPI:1073548962
Name:MOSCOSO, L R ROBERTO (MD)
Entity Type:Individual
Prefix:MR
First Name:L R
Middle Name:ROBERTO
Last Name:MOSCOSO
Suffix:
Gender:M
Credentials:MD
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Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1901 TOWN AND COUNTRY DR
Mailing Address - Street 2:STE 104
Mailing Address - City:NORCO
Mailing Address - State:CA
Mailing Address - Zip Code:92860-3611
Mailing Address - Country:US
Mailing Address - Phone:951-734-4880
Mailing Address - Fax:951-734-7963
Practice Address - Street 1:2250 S MAIN ST
Practice Address - Street 2:SUITE #201
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92882-5302
Practice Address - Country:US
Practice Address - Phone:951-734-4880
Practice Address - Fax:951-734-7963
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2021-01-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA46145207RC0000X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A461450Medicare PIN
CAE78086Medicare UPIN