Provider Demographics
NPI:1801254222
Name:MOZES, LARISSA
Entity type:Individual
Prefix:
First Name:LARISSA
Middle Name:
Last Name:MOZES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18756 ERWIN ST
Mailing Address - Street 2:
Mailing Address - City:TARZANA
Mailing Address - State:CA
Mailing Address - Zip Code:91335-6825
Mailing Address - Country:US
Mailing Address - Phone:818-350-3264
Mailing Address - Fax:
Practice Address - Street 1:23201 MILL CREEK DR STE 221
Practice Address - Street 2:
Practice Address - City:LAGUNA HILLS
Practice Address - State:CA
Practice Address - Zip Code:92653-7906
Practice Address - Country:US
Practice Address - Phone:818-350-3264
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-29
Last Update Date:2024-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA111343251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health