Provider Demographics
NPI:1558566315
Name:MOOZA, ALEXANDER FABIEN (MD)
Entity Type:Individual
Prefix:
First Name:ALEXANDER
Middle Name:FABIEN
Last Name:MOOZA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2810 W CHARLESTON BLVD
Mailing Address - Street 2:SUITE 78
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89102-1921
Mailing Address - Country:US
Mailing Address - Phone:702-870-3415
Mailing Address - Fax:
Practice Address - Street 1:2810 W CHARLESTON BLVD
Practice Address - Street 2:SUITE 78
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89102-1921
Practice Address - Country:US
Practice Address - Phone:702-870-3415
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-20
Last Update Date:2008-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVLL16542084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry