Healthcare Provider Details

I. General information

NPI: 1134048283
Provider Name (Legal Business Name): MOON PEDIATRIC THERAPY INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/13/2026
Last Update Date: 07/13/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9760 LITTLE CANYON LN
ESCONDIDO CA
92026
US

IV. Provider business mailing address

1111 6TH AVE STE 550
SAN DIEGO CA
92101-5211
US

V. Phone/Fax

Practice location:
  • Phone: 619-925-6795
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State

VIII. Authorized Official

Name: ISAIAH RAMOS
Title or Position: PROGRAM DIRECTOR
Credential:
Phone: 951-500-2964