Provider Demographics
NPI:1154868552
Name:MOSELEY, TONI LEA BIRCH (NP)
Entity Type:Individual
Prefix:
First Name:TONI
Middle Name:LEA BIRCH
Last Name:MOSELEY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 232410
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92193-2410
Mailing Address - Country:US
Mailing Address - Phone:858-657-7174
Mailing Address - Fax:858-657-5058
Practice Address - Street 1:9434 MEDICAL CENTER DR
Practice Address - Street 2:MAIL CODE 7892
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92037-1337
Practice Address - Country:US
Practice Address - Phone:858-657-7174
Practice Address - Fax:858-657-5058
Is Sole Proprietor?:No
Enumeration Date:2017-01-23
Last Update Date:2018-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95004933363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner