Healthcare Provider Details

I. General information

NPI: 1093954018
Provider Name (Legal Business Name): JUAN MOCEGA MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/14/2009
Last Update Date: 02/14/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1141 W REDONDO BEACH BLVD SUITE 308
GARDENA CA
90247-3586
US

IV. Provider business mailing address

1141 W REDONDO BEACH BLVD SUITE 308
GARDENA CA
90247-3586
US

V. Phone/Fax

Practice location:
  • Phone: 310-807-9477
  • Fax: 310-515-6474
Mailing address:
  • Phone: 310-807-9477
  • Fax: 310-515-6474

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberG41952
License Number StateCA

VIII. Authorized Official

Name: DR. JUAN A MOCEGA
Title or Position: CEO
Credential: MD
Phone: 310-807-9477