Active NPI
Jackson Ariel Moscoso, SURGICAL ASSISTANT
- Surgical Assistant
- Fairfax, VA
National Provider Identifier
1720625080
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Surgical Assistant
- License
- 5092
- Practice address
- 3127 Plantation Pkwy
Fairfax, VA 22030-2117 - Phone
- (571) 594-8144
- NPI assigned
- Dec 5, 2019
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Surgical Assistant | 246ZC0007X | 5092 | VA | Primary |
Addresses
Primary practice location
3127 Plantation Pkwy
Fairfax, VA 22030-2117
Mailing address
3127 Plantation Pkwy
Fairfax, VA 22030-2117
Phone (571) 594-8144
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5092 | VA | MD | Surgical Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1575504000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1577750400000",
"number": "1720625080",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3127 PLANTATION PKWY",
"city": "FAIRFAX",
"state": "VA",
"postal_code": "220302117",
"telephone_number": "571-594-8144"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3127 PLANTATION PKWY",
"city": "FAIRFAX",
"state": "VA",
"postal_code": "220302117",
"telephone_number": "571-594-8144"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MOSCOSO",
"first_name": "JACKSON",
"middle_name": "ARIEL",
"credential": "SURGICAL ASSISTANT",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2019-12-05",
"last_updated": "2019-12-31",
"certification_date": "2019-12-31",
"status": "A"
},
"taxonomies": [
{
"code": "246ZC0007X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Specialist/Technologist, Other, Surgical Assistant",
"state": "VA",
"license": "5092",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fairfax, VA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 31, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.