Individual
JACKSON ARIEL MOSCOSO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
SURGICAL ASSISTANT
Contact information
Practice address
3127 PLANTATION PKWY, FAIRFAX, VA 22030-2117
(571) 594-8144
Mailing address
3127 PLANTATION PKWY, FAIRFAX, VA 22030-2117
(571) 594-8144
Taxonomy
Speciality
Code
Description
License number
State
246ZC0007X
Surgical Assistant
Primary
5092
VA
Other
Enumeration date
12/05/2019
Last updated
12/31/2019
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