Provider Demographics
NPI:1235213828
Name:MOSESI, GEVORK
Entity Type:Individual
Prefix:
First Name:GEVORK
Middle Name:
Last Name:MOSESI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1019 E GLENOAKS BLVD
Mailing Address - Street 2:# 206
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91206-2145
Mailing Address - Country:US
Mailing Address - Phone:909-469-9494
Mailing Address - Fax:909-397-9809
Practice Address - Street 1:1770 N ORANGE GROVE AVE
Practice Address - Street 2:# 101
Practice Address - City:POMONA
Practice Address - State:CA
Practice Address - Zip Code:91767-3027
Practice Address - Country:US
Practice Address - Phone:909-469-9494
Practice Address - Fax:909-397-9809
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2021-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program