Provider Demographics
NPI:1861503609
Name:MOSS, ROBERT ALLAN (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:ALLAN
Last Name:MOSS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:11180 WARNER AVE STE 467
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92708-7505
Mailing Address - Country:US
Mailing Address - Phone:714-641-1128
Mailing Address - Fax:714-540-7610
Practice Address - Street 1:11180 WARNER AVE STE 467
Practice Address - Street 2:
Practice Address - City:FOUNTAIN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92708-7505
Practice Address - Country:US
Practice Address - Phone:714-641-1128
Practice Address - Fax:714-540-7610
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2020-01-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG33764207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G337640Medicaid
CA00G337640Medicaid
CAG33764Medicare PIN