Healthcare Provider Details

I. General information

NPI: 1679408975
Provider Name (Legal Business Name): AMEYALLI MOYA DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2026
Last Update Date: 06/17/2026
Certification Date: 06/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10189 CITRUS AVE STE 500
FONTANA CA
92335-6449
US

IV. Provider business mailing address

3885 HIDDEN TRAIL DR
JAMUL CA
91935-2113
US

V. Phone/Fax

Practice location:
  • Phone: 909-657-2736
  • Fax:
Mailing address:
  • Phone: 619-201-0070
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number113138
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: