Provider Demographics
NPI:1780340166
Name:MOSKUS, PATRICK ROYCE
Entity type:Individual
Prefix:
First Name:PATRICK
Middle Name:ROYCE
Last Name:MOSKUS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14128 PRAIRIE CREEK PL
Mailing Address - Street 2:
Mailing Address - City:EASTVALE
Mailing Address - State:CA
Mailing Address - Zip Code:92880-3397
Mailing Address - Country:US
Mailing Address - Phone:909-974-8094
Mailing Address - Fax:
Practice Address - Street 1:14128 PRAIRIE CREEK PL
Practice Address - Street 2:
Practice Address - City:EASTVALE
Practice Address - State:CA
Practice Address - Zip Code:92880-3397
Practice Address - Country:US
Practice Address - Phone:909-974-8094
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-10
Last Update Date:2021-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA334700168251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health