Provider Demographics
NPI:1740440296
Name:MOSS, ARCIA LARAY (RSA-C)
Entity type:Individual
Prefix:MR
First Name:ARCIA
Middle Name:LARAY
Last Name:MOSS
Suffix:
Gender:M
Credentials:RSA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:485 TYLER CT
Mailing Address - Street 2:
Mailing Address - City:VERNON HILLS
Mailing Address - State:IL
Mailing Address - Zip Code:60061-1372
Mailing Address - Country:US
Mailing Address - Phone:847-932-9680
Mailing Address - Fax:
Practice Address - Street 1:485 TYLER CT
Practice Address - Street 2:
Practice Address - City:VERNON HILLS
Practice Address - State:IL
Practice Address - Zip Code:60061-1372
Practice Address - Country:US
Practice Address - Phone:847-932-9680
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-09
Last Update Date:2008-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL238.000114246ZS0410X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZS0410XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Technologist