Provider Demographics
NPI:1750650867
Name:MOSES, PRECIOUS JEWEL (LVN)
Entity Type:Individual
Prefix:
First Name:PRECIOUS
Middle Name:JEWEL
Last Name:MOSES
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14608 YUKON AVE
Mailing Address - Street 2:SUITE 23
Mailing Address - City:HAWTHORNE
Mailing Address - State:CA
Mailing Address - Zip Code:90250-8542
Mailing Address - Country:US
Mailing Address - Phone:323-474-1436
Mailing Address - Fax:424-456-7323
Practice Address - Street 1:14608 YUKON AVE
Practice Address - Street 2:SUITE 23
Practice Address - City:HAWTHORNE
Practice Address - State:CA
Practice Address - Zip Code:90250-8542
Practice Address - Country:US
Practice Address - Phone:323-474-1436
Practice Address - Fax:424-456-7323
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-19
Last Update Date:2011-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA235621164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse