Healthcare Provider Details

I. General information

NPI: 1770238438
Provider Name (Legal Business Name): MOE MYAT FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/21/2022
Last Update Date: 02/21/2022
Certification Date: 02/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2915 TELEGRAPH AVE STE 302
BERKELEY CA
94705-2030
US

IV. Provider business mailing address

2915 TELEGRAPH AVE STE 302
BERKELEY CA
94705-2030
US

V. Phone/Fax

Practice location:
  • Phone: 866-983-3167
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberNP95019646
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: