Provider Demographics
NPI:1205966504
Name:MOSCA, THOMAS MICHAEL (DC)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:MICHAEL
Last Name:MOSCA
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 S SANTA CRUZ AVE STE 207
Mailing Address - Street 2:
Mailing Address - City:LOS GATOS
Mailing Address - State:CA
Mailing Address - Zip Code:95030-6827
Mailing Address - Country:US
Mailing Address - Phone:408-354-5645
Mailing Address - Fax:408-354-5945
Practice Address - Street 1:20 S SANTA CRUZ AVE STE 207
Practice Address - Street 2:
Practice Address - City:LOS GATOS
Practice Address - State:CA
Practice Address - Zip Code:95030-6827
Practice Address - Country:US
Practice Address - Phone:408-354-5645
Practice Address - Fax:408-354-5945
Is Sole Proprietor?:No
Enumeration Date:2007-03-06
Last Update Date:2010-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC0199250111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAT93502Medicare UPIN