Healthcare Provider Details

I. General information

NPI: 1669087698
Provider Name (Legal Business Name): FATIMA ZAHRA MOON PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2020
Last Update Date: 01/27/2026
Certification Date: 01/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15910 VENTURA BLVD STE 1510
ENCINO CA
91436-2827
US

IV. Provider business mailing address

15910 VENTURA BLVD STE 1510
ENCINO CA
91436-2827
US

V. Phone/Fax

Practice location:
  • Phone: 310-278-9171
  • Fax:
Mailing address:
  • Phone: 469-835-8560
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: