Provider Demographics
NPI:1407906670
Name:MOSELEY, ANA LUISA (SOCIAL WORKER)
Entity Type:Individual
Prefix:
First Name:ANA
Middle Name:LUISA
Last Name:MOSELEY
Suffix:
Gender:F
Credentials:SOCIAL WORKER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1202 ONATE ST
Mailing Address - Street 2:
Mailing Address - City:ANTHONY
Mailing Address - State:NM
Mailing Address - Zip Code:88021-7241
Mailing Address - Country:US
Mailing Address - Phone:915-269-2081
Mailing Address - Fax:505-824-0820
Practice Address - Street 1:LA CLINICA DE FAMILIA
Practice Address - Street 2:1100 S MAIN ST
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88012
Practice Address - Country:US
Practice Address - Phone:505-824-0820
Practice Address - Fax:505-824-1021
Is Sole Proprietor?:No
Enumeration Date:2007-01-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX412061041C0700X
NMI 19261041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical