Provider Demographics
NPI:1932547122
Name:MOASIS, GHASSAN A (MD)
Entity Type:Individual
Prefix:DR
First Name:GHASSAN
Middle Name:A
Last Name:MOASIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:GHASSAN
Other - Middle Name:
Other - Last Name:AL MOASIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:10170 SORRENTO VALLEY RD
Mailing Address - Street 2:MAIL DROP SV-5
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92121-1604
Mailing Address - Country:US
Mailing Address - Phone:858-784-5888
Mailing Address - Fax:
Practice Address - Street 1:9850 GENESEE AVE
Practice Address - Street 2:SUITE 560
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92037-1224
Practice Address - Country:US
Practice Address - Phone:858-455-6330
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-10
Last Update Date:2016-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC134031208G00000X
OH35050944208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHH220410Medicare PIN
OH0599393Medicaid