MEDICARE: DR. AMIR MOLDOVAN MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RR0500X	Rheumatology Physician	A104056	CA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	GC959Z	OTHER	CA	MEDICARE PTAN

General Provider Information

NPI Number	:	1295777837
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. AMIR MOLDOVAN MD

Provider Business Mailing Address
First Line	:	23206 LYONS AVENUE
Second Line	:	SUITE 106
City	:	SANTA CLARITA
State	:	CA
Zip	:	92321-2671
Country	:	US
Telephone Number	:	661-505-9901
Fax Number	:	661-505-9902

Provider Business Practice Location Address
First Line	:	23206 LYONS AVENUE
Second Line	:	SUITE 106
City	:	SANTA CLARITA
State	:	CA
Zip	:	92321-2671
Country	:	US
Telephone Number	:	661-505-9901
Fax Number	:	661-505-9902

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/11/2006
Last Update Date	:	02/12/2020

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