Healthcare Provider Details

I. General information

NPI: 1609992882
Provider Name (Legal Business Name): MS. AIDA MONIKA MOYA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/21/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3333 E AMERICAN AVE
FRESNO CA
93725-9235
US

IV. Provider business mailing address

3718 W VINCENT LN
FRESNO CA
93711-4106
US

V. Phone/Fax

Practice location:
  • Phone: 559-495-3811
  • Fax:
Mailing address:
  • Phone: 559-681-3089
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3245S0500X
TaxonomyChildren's Substance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: