Healthcare Provider Details

I. General information

NPI: 1023339413
Provider Name (Legal Business Name): CLARE ELIZABETH MOYNIHAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2010
Last Update Date: 04/15/2024
Certification Date: 04/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5800 HOLLIS ST
EMERYVILLE CA
94608-2016
US

IV. Provider business mailing address

5800 HOLLIS ST
EMERYVILLE CA
94608-2016
US

V. Phone/Fax

Practice location:
  • Phone: 510-806-2100
  • Fax:
Mailing address:
  • Phone: 510-806-2100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA137429
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number2012016765
License Number StateMO
# 3
Primary TaxonomyN
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number2012016765
License Number StateMO
# 4
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License NumberA137429
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: