Mark Mousa, MD
Family Medicine in Victorville, CA. Individual provider (NPI-1).
NPI number1104497684
StatusActive
Last updated in NPPESAug 1, 2024
Details
- NPI
- 1104497684
- Entity type
- Individual (NPI-1)
- Name
- Mark Mousa
- Credential
- MD
- Sex
- Male
- Sole proprietor
- No
- Enumeration date
- Jul 7, 2021
- Certification date
- Jul 16, 2024
- Last updated
- Aug 1, 2024
Medicare and OIG
- Medicare enrolled (PECOS)
- Yes · PRACTITIONER - FAMILY PRACTICE
- Can order and refer
- Part B Yes · DME Yes · Home health Yes · Power mobility Yes · Hospice Yes
- OIG exclusion list
- This NPI is not listed
CMS and OIG files of November 2026. PECOS lookup · OIG exclusion check
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 207Q00000X | Family Medicine | A195563 | CA | Yes |
Practice location
12550 Hesperia Rd Ste 100Victorville, CA 92395-5873
Phone 760-241-6666
Mailing address
200 Hawkins DrIowa City, IA 52242-1009
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This page shows exactly what the provider filed with NPPES. Only the provider (or their surrogate) can change it, by signing in to NPPES. Our page updates within a day of their change. See how to update NPI information.
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