Provider Demographics
NPI:1023177607
Name:MOSES, DEVADAS S (MD, FACP, DRPH)
Entity type:Individual
Prefix:DR
First Name:DEVADAS
Middle Name:S
Last Name:MOSES
Suffix:
Gender:M
Credentials:MD, FACP, DRPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 HIGHLAND SPRINGS AVE STE 5
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:CA
Mailing Address - Zip Code:92223-2550
Mailing Address - Country:US
Mailing Address - Phone:951-845-2342
Mailing Address - Fax:951-845-0084
Practice Address - Street 1:701 HIGHLAND SPRINGS AVE STE 5
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:CA
Practice Address - Zip Code:92223-2550
Practice Address - Country:US
Practice Address - Phone:951-845-2342
Practice Address - Fax:951-845-0084
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-08
Last Update Date:2023-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA46492207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A464920Medicaid
CA00A464920Medicaid