Healthcare Provider Details

I. General information

NPI: 1700831971
Provider Name (Legal Business Name): RICHARD R MOY DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/24/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29300 PORTOLA PKWY SUITE B
LAKE FOREST CA
92630-8718
US

IV. Provider business mailing address

29300 PORTOLA PKWY SUITE B
LAKE FOREST CA
92630-8718
US

V. Phone/Fax

Practice location:
  • Phone: 949-837-3338
  • Fax: 949-716-2725
Mailing address:
  • Phone: 949-837-3338
  • Fax: 949-716-2725

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberE3833
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: