Healthcare Provider Details

I. General information

NPI: 1457576167
Provider Name (Legal Business Name): MOONFIELD MEDICAL MGMT. CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/16/2007
Last Update Date: 10/30/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

710 E PARKRIDGE AVE
CORONA CA
92879-1097
US

IV. Provider business mailing address

PO BOX 1269
CORONA CA
92878-1269
US

V. Phone/Fax

Practice location:
  • Phone: 951-734-7600
  • Fax: 951-734-1557
Mailing address:
  • Phone: 951-734-7600
  • Fax: 951-734-1557

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberA032377
License Number StateCA

VIII. Authorized Official

Name: DR. MOON Y. LEE
Title or Position: PRESIDENT
Credential: M.D.
Phone: 951-734-7600