Provider Demographics
NPI:1255776449
Name:LAYNO-MOSES, ANNIE RENEE
Entity type:Individual
Prefix:
First Name:ANNIE
Middle Name:RENEE
Last Name:LAYNO-MOSES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2801 WILSHIRE BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90403-4801
Mailing Address - Country:US
Mailing Address - Phone:310-574-2777
Mailing Address - Fax:
Practice Address - Street 1:588 BROADWAY RM 710
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10012-5242
Practice Address - Country:US
Practice Address - Phone:212-804-9060
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-01
Last Update Date:2022-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA1497082081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine