Healthcare Provider Details

I. General information

NPI: 1396973699
Provider Name (Legal Business Name): PAUL MOYA DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2009
Last Update Date: 11/20/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 S GRAND AVE STE 415
GLENDORA CA
91741-4292
US

IV. Provider business mailing address

210 S GRAND AVE STE 415
GLENDORA CA
91741-4292
US

V. Phone/Fax

Practice location:
  • Phone: 626-335-3627
  • Fax: 626-335-4806
Mailing address:
  • Phone: 626-335-3627
  • Fax: 626-335-4806

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number20A11804
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: