Provider Demographics
NPI:1346284734
Name:MOSS, HOWARD MARTIN (MD)
Entity Type:Individual
Prefix:DR
First Name:HOWARD
Middle Name:MARTIN
Last Name:MOSS
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:2080 CENTURY PARK E
Mailing Address - Street 2:SUITE 1703
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90067-2001
Mailing Address - Country:US
Mailing Address - Phone:310-553-2080
Mailing Address - Fax:310-553-2507
Practice Address - Street 1:2080 CENTURY PARK E
Practice Address - Street 2:SUITE 1703
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90067-2001
Practice Address - Country:US
Practice Address - Phone:310-553-2080
Practice Address - Fax:310-553-2507
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-15
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA20242207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA20242OtherCA LICENSE
CAA20242OtherCA LICENSE