Provider Demographics
NPI:1164789459
Name:JOSEPH MOZA, MD, INC
Entity Type:Organization
Organization Name:JOSEPH MOZA, MD, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:MOZA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:760-326-7279
Mailing Address - Street 1:PO BOX 2333
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92659-1333
Mailing Address - Country:US
Mailing Address - Phone:559-281-1024
Mailing Address - Fax:
Practice Address - Street 1:28 EBB TIDE CIR
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92663-2842
Practice Address - Country:US
Practice Address - Phone:760-370-0209
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-12
Last Update Date:2023-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA 44933208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1164789459Medicaid
CA1356336127Medicaid