Healthcare Provider Details

I. General information

NPI: 1689210825
Provider Name (Legal Business Name): MOYNIHAN FAMILY PRACTICE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/22/2019
Last Update Date: 11/22/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6620 COYLE AVE STE 416
CARMICHAEL CA
95608-6338
US

IV. Provider business mailing address

PO BOX 632
DAVIS CA
95617-0632
US

V. Phone/Fax

Practice location:
  • Phone: 530-400-4880
  • Fax:
Mailing address:
  • Phone: 530-400-4880
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. KEVIN M MOYNIHAN
Title or Position: OWNER/PRESIDENT/PHYSICIAN
Credential: MD
Phone: 530-400-4880