Individual
CIVANNI MOSS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3401 N BROAD ST, PHILADELPHIA, PA 19140-5103
(800) 836-7536
Mailing address
2411 KENSINGTON AVE APT 303, PHILADELPHIA, PA 19125-1258
(703) 577-6400
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
04/13/2023
Last updated
04/13/2023
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