Provider Demographics
NPI:1457117798
Name:DEVADAS MOSES, A PROFESSIONAL MEDICAL CORPORATION. MOSES CLINIC
Entity Type:Organization
Organization Name:DEVADAS MOSES, A PROFESSIONAL MEDICAL CORPORATION. MOSES CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:MRS
Authorized Official - First Name:DEVADAS
Authorized Official - Middle Name:S
Authorized Official - Last Name:MOSES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:909-533-7295
Mailing Address - Street 1:25406 COLE ST
Mailing Address - Street 2:
Mailing Address - City:LOMA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92354-3186
Mailing Address - Country:US
Mailing Address - Phone:909-533-7295
Mailing Address - Fax:
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-26
Last Update Date:2024-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty