Provider Demographics
NPI:1417110347
Name:BARBOZA, MORIAH PSALM (NP)
Entity Type:Individual
Prefix:
First Name:MORIAH
Middle Name:PSALM
Last Name:BARBOZA
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 1:1275 E LATHAM AVE STE A
Mailing Address - Street 2:
Mailing Address - City:HEMET
Mailing Address - State:CA
Mailing Address - Zip Code:92543-4424
Mailing Address - Country:US
Mailing Address - Phone:951-652-5555
Mailing Address - Fax:951-766-5056
Practice Address - Street 1:36867 COOK ST STE 101
Practice Address - Street 2:
Practice Address - City:PALM DESERT
Practice Address - State:CA
Practice Address - Zip Code:92211-6064
Practice Address - Country:US
Practice Address - Phone:760-341-1999
Practice Address - Fax:760-341-1997
Is Sole Proprietor?:No
Enumeration Date:2008-07-10
Last Update Date:2022-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA18237363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner