Provider Demographics
NPI:1235118233
Name:MOSBY, ANGELA Y (MD)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:Y
Last Name:MOSBY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5767 W CENTURY BLVD STE 400
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90045-5631
Mailing Address - Country:US
Mailing Address - Phone:310-301-8774
Mailing Address - Fax:
Practice Address - Street 1:2360 CORPORATE CIR STE 280
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89074-7718
Practice Address - Country:US
Practice Address - Phone:702-961-0164
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-10
Last Update Date:2024-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV26741207Q00000X
OK22320207Q00000X
CAC136817207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100072380AMedicaid
OK24M802901Medicare PIN
OKH41374Medicare UPIN