Provider Demographics
NPI:1154633311
Name:MOOSAD, MALA (RN LAC)
Entity Type:Individual
Prefix:MRS
First Name:MALA
Middle Name:
Last Name:MOOSAD
Suffix:
Gender:F
Credentials:RN LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 E LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92865-1905
Mailing Address - Country:US
Mailing Address - Phone:714-637-6370
Mailing Address - Fax:714-637-2744
Practice Address - Street 1:900 E LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92865-1905
Practice Address - Country:US
Practice Address - Phone:714-637-6370
Practice Address - Fax:714-637-2744
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-04
Last Update Date:2010-07-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARN483238163W00000X
CAAC6915171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No171100000XOther Service ProvidersAcupuncturist