Healthcare Provider Details

I. General information

NPI: 1700181450
Provider Name (Legal Business Name): NOOSHIN MEGAN MOALEMI D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/11/2011
Last Update Date: 09/19/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2740 HERNDON AVE
CLOVIS CA
93611-6813
US

IV. Provider business mailing address

2740 HERNDON AVE
CLOVIS CA
93611-6813
US

V. Phone/Fax

Practice location:
  • Phone: 559-299-2578
  • Fax: 559-299-0245
Mailing address:
  • Phone: 559-299-2578
  • Fax: 559-299-0245

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number20A11628
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: