Provider Demographics
NPI:1912619040
Name:MOSLEY, RAYNISHA
Entity Type:Individual
Prefix:MS
First Name:RAYNISHA
Middle Name:
Last Name:MOSLEY
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 1:21935 VAN BUREN ST STE B-7
Mailing Address - Street 2:
Mailing Address - City:GRAND TERRACE
Mailing Address - State:CA
Mailing Address - Zip Code:92313-5652
Mailing Address - Country:US
Mailing Address - Phone:909-906-1023
Mailing Address - Fax:
Practice Address - Street 1:21935 VAN BUREN ST
Practice Address - Street 2:STE B-7
Practice Address - City:GRAND TERRACE
Practice Address - State:CA
Practice Address - Zip Code:92313
Practice Address - Country:US
Practice Address - Phone:909-906-1023
Practice Address - Fax:909-906-1032
Is Sole Proprietor?:No
Enumeration Date:2022-12-20
Last Update Date:2022-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker