Organization
DEVADAS MOSES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. DHARMASEELI E MOSES (CLINICAL SERVICES COORDINATOR)
(951) 715-3448
Entity
Organization
Contact information
Practice address
2880 HULEN PL, RIVERSIDE, CA 92507-2606
(951) 715-3448
(951) 715-3449
Mailing address
2880 HULEN PL, RIVERSIDE, CA 92507-2606
(951) 715-3448
(951) 715-3449
Taxonomy
Speciality
Code
Description
License number
State
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
A046492
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00A464920
—
CA
Enumeration date
10/19/2012
Last updated
10/19/2012
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