Provider Demographics
NPI:1679718027
Name:MOSS, VICTORIA ROSE (MD)
Entity type:Individual
Prefix:DR
First Name:VICTORIA
Middle Name:ROSE
Last Name:MOSS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:VICTORIA
Other - Middle Name:ROSE
Other - Last Name:NEGRETE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:12320 ORACLE BLVD STE 350
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80921-2543
Mailing Address - Country:US
Mailing Address - Phone:719-355-1585
Mailing Address - Fax:920-684-1439
Practice Address - Street 1:9348 GRAND CORDERA PKWY STE 160
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80924-7023
Practice Address - Country:US
Practice Address - Phone:719-355-1585
Practice Address - Fax:719-623-2983
Is Sole Proprietor?:No
Enumeration Date:2008-12-12
Last Update Date:2024-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01082823A207N00000X
WI53961-020207N00000X
CODR.0072440207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CODR.0072440OtherLICENSE
COFM4062802OtherDEA
WI53961-020OtherSTATE LICENSE
WIFN1844427OtherDEA
IN01082823AOtherSTATE LICENSE