Provider Demographics
NPI:1558530816
Name:J. MOSS FOUNDATION
Entity Type:Organization
Organization Name:J. MOSS FOUNDATION
Other - Org Name:SKINNY GENE PROJECT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BOARD MEMBER/MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JESSE
Authorized Official - Middle Name:
Authorized Official - Last Name:MOSS
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:210-656-8888
Mailing Address - Street 1:10620 TREENA ST
Mailing Address - Street 2:SUITE 230
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92131-1140
Mailing Address - Country:US
Mailing Address - Phone:619-793-2010
Mailing Address - Fax:858-408-1891
Practice Address - Street 1:12602 TOEPPERWEIN RD
Practice Address - Street 2:SUITE 211
Practice Address - City:LIVE OAK
Practice Address - State:TX
Practice Address - Zip Code:78233-3269
Practice Address - Country:US
Practice Address - Phone:210-656-8888
Practice Address - Fax:210-656-2608
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-20
Last Update Date:2016-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH3795207YX0905X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207YX0905XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngology/Facial Plastic SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00766ZMedicare PIN