Provider Demographics
NPI:1437990595
Name:MOSER, JORDAN (PA-C)
Entity type:Individual
Prefix:
First Name:JORDAN
Middle Name:
Last Name:MOSER
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19019 GAS POINT RD
Mailing Address - Street 2:
Mailing Address - City:COTTONWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:96022-9107
Mailing Address - Country:US
Mailing Address - Phone:909-644-2189
Mailing Address - Fax:
Practice Address - Street 1:7981 HIGHWAY 99E
Practice Address - Street 2:
Practice Address - City:LOS MOLINOS
Practice Address - State:CA
Practice Address - Zip Code:96055-9782
Practice Address - Country:US
Practice Address - Phone:530-384-4010
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-03
Last Update Date:2025-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant