Provider Demographics
NPI:1457359515
Name:MOORSTEIN, BRUCE D (MD)
Entity Type:Individual
Prefix:
First Name:BRUCE
Middle Name:D
Last Name:MOORSTEIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:350 30TH ST STE 430
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94609-3426
Mailing Address - Country:US
Mailing Address - Phone:510-835-2070
Mailing Address - Fax:510-835-2433
Practice Address - Street 1:350 30TH ST STE 430
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94609-3426
Practice Address - Country:US
Practice Address - Phone:510-835-2070
Practice Address - Fax:510-835-2433
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-12
Last Update Date:2016-05-23
Deactivation Date:2006-03-25
Deactivation Code:
Reactivation Date:2006-04-12
Provider Licenses
StateLicense IDTaxonomies
CAA29377208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A293770Medicaid
CA00A293770Medicaid
CAZZZ06548ZMedicare PIN