Provider Demographics
NPI:1144748211
Name:MOGA, CLAIRE SULLIVAN (FNP, DNP)
Entity Type:Individual
Prefix:DR
First Name:CLAIRE
Middle Name:SULLIVAN
Last Name:MOGA
Suffix:
Gender:F
Credentials:FNP, DNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 25100
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93729-5100
Mailing Address - Country:US
Mailing Address - Phone:559-326-1222
Mailing Address - Fax:559-326-1230
Practice Address - Street 1:838 NORDAHL RD STE 300
Practice Address - Street 2:
Practice Address - City:SAN MARCOS
Practice Address - State:CA
Practice Address - Zip Code:92069-3599
Practice Address - Country:US
Practice Address - Phone:760-074-7089
Practice Address - Fax:760-466-0078
Is Sole Proprietor?:No
Enumeration Date:2017-09-08
Last Update Date:2020-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95007255363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily