Basic Information
| Provider Information | |||||||||
| NPI: | 1235118233 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MOSBY | ||||||||
| FirstName: | ANGELA | ||||||||
| MiddleName: | Y | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5767 W CENTURY BLVD STE 400 | ||||||||
| Address2: | |||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900455631 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3103018774 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 6000 SEPULVEDA BLVD STE 2660 | ||||||||
| Address2: | |||||||||
| City: | CULVER CITY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 902306432 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3103130020 | ||||||||
| FaxNumber: | 3103130060 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/10/2006 | ||||||||
| LastUpdateDate: | 11/03/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/03/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 22320 | OK | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | C136817 | CA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 100072380A | 05 | OK | MEDICAID |