Provider Demographics
NPI:1114910551
Name:MOZELSIO, NANCY BROITMAN (MD)
Entity Type:Individual
Prefix:DR
First Name:NANCY
Middle Name:BROITMAN
Last Name:MOZELSIO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 LA CASA VIA
Mailing Address - Street 2:BLDG 2, #209
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94598-3045
Mailing Address - Country:US
Mailing Address - Phone:925-935-6252
Mailing Address - Fax:925-930-0942
Practice Address - Street 1:130 LA CASA VIA
Practice Address - Street 2:BLDG 2, #209
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94598-3045
Practice Address - Country:US
Practice Address - Phone:925-935-6252
Practice Address - Fax:925-930-0942
Is Sole Proprietor?:No
Enumeration Date:2005-08-30
Last Update Date:2011-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA75031207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A750310Medicare ID - Type Unspecified
CAH68310Medicare UPIN