MEDICARE: DAVID EMMANUEL MOYAL PA

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	207P00000X	Emergency Medicine Physician	PA11278	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	OPA112781	OTHER	CA	BLUE SHIELD
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1548251960
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAVID EMMANUEL MOYAL PA

Provider Business Mailing Address
First Line	:	4301 NORTHSTAR WAY
Second Line	:
City	:	MODESTO
State	:	CA
Zip	:	95356-9262
Country	:	US
Telephone Number	:	209-342-2300
Fax Number	:	209-524-4240

Provider Business Practice Location Address
First Line	:	20103 LAKE CHABOT RD
Second Line	:	EMERGENCY DEPT
City	:	CASTRO VALLEY
State	:	CA
Zip	:	94546-5305
Country	:	US
Telephone Number	:	209-342-2300
Fax Number	:	209-524-4240

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

Provider Enumeration Date	:	11/03/2005
Last Update Date	:	08/27/2008

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