Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Mark Mousa, MD

Individual provider Family Medicine Physician · NPI 1104497684

Mark Mousa, MD is a Family Practice in Victorville, California. Qualified in 2020, 6 years ago. Practices with Providence Medical Foundation, a 1,465-clinician group, accepts Medicare assignment and offers telehealth. Licensed in California.

Years since qualifying
6
Licensed in
CA
In the registry since
2021
What do these letters mean?
MD — Doctor of Medicine
A physician who completed allopathic medical school.

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Practice location Address checks out

12550 Hesperia Rd Ste 100
Victorville, CA 92395-5873
Phone: (760) 241-6666
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Family Medicine Physician (primary) Taxonomy 207Q00000X · Licence A195563 (CA)

Record details

NPI number1104497684
Entity typeIndividual (Type 1)
GenderMale
Credentials MD
Sole proprietorNo
NPI enumeratedJuly 7, 2021
Last updated in NPPESAugust 1, 2024
Certification dateJuly 16, 2024

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyFAMILY PRACTICE
Medical schoolOTHER
Graduated 2020 (6 years in practice)
Group practice Providence Medical Foundation — 1465 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
TelehealthOffers telehealth services

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