Charles Allen Moss, MD
Individual provider Active NPI Family Medicine Physician · La Jollaa, CA
NPI 1215055207 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1215055207
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- G033632 (CA)
- Practice address
- 8950 Villa la Jolla Drive
A217
La Jollaa, CA 92037-1711 - Phone
- (858) 457-1314
- Fax
- (858) 457-3615
- NPI assigned
- Mar 27, 2007
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
- Opted out of Medicare
- Yes, effective Jul 24, 2024 through Jul 24, 2028
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| G033632 | CA | MD | Family Medicine Physician |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | G033632 | CA | Yes |
Addresses
Primary practice location
8950 Villa la Jolla Drive
A217
La Jollaa, CA 92037-1711
Mailing address
8950 Villa la Jolla Drive
A217
La Jollaa, CA 92037-1711
Phone (858) 457-1314
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Opt Out Affidavits (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.