Provider Demographics
NPI:1093703282
Name:MOISE, LAURENE SUSAN (MD)
Entity Type:Individual
Prefix:
First Name:LAURENE
Middle Name:SUSAN
Last Name:MOISE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:23805 STUART RANCH RD
Mailing Address - Street 2:SUITE 230
Mailing Address - City:MALIBU
Mailing Address - State:CA
Mailing Address - Zip Code:90265-4856
Mailing Address - Country:US
Mailing Address - Phone:310-456-0333
Mailing Address - Fax:310-317-7003
Practice Address - Street 1:23805 STUART RANCH RD
Practice Address - Street 2:SUITE 230
Practice Address - City:MALIBU
Practice Address - State:CA
Practice Address - Zip Code:90265-4856
Practice Address - Country:US
Practice Address - Phone:310-456-0333
Practice Address - Fax:310-317-7003
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-11
Last Update Date:2010-09-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAG53441207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
A93225Medicare UPIN