Provider Demographics
NPI:1801048079
Name:MOSS, RONALD B (MD)
Entity type:Individual
Prefix:
First Name:RONALD
Middle Name:B
Last Name:MOSS
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:PO BOX 41
Mailing Address - Street 2:
Mailing Address - City:SOLANA BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92075-0041
Mailing Address - Country:US
Mailing Address - Phone:619-742-6035
Mailing Address - Fax:
Practice Address - Street 1:345 SAXONY RD STE 105
Practice Address - Street 2:
Practice Address - City:ENCINITAS
Practice Address - State:CA
Practice Address - Zip Code:92024-2787
Practice Address - Country:US
Practice Address - Phone:760-436-6404
Practice Address - Fax:760-462-3986
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-18
Last Update Date:2015-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG79340261QC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health