Healthcare Provider Details

I. General information

NPI: 1891106076
Provider Name (Legal Business Name): ANTONIO MOYA MD, MPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/09/2014
Last Update Date: 05/20/2020
Certification Date: 05/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 GLENDON AVE STE 900
LOS ANGELES CA
90024-3513
US

IV. Provider business mailing address

1100 GLENDON AVE STE 900
LOS ANGELES CA
90024-3513
US

V. Phone/Fax

Practice location:
  • Phone: 310-794-2268
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberA155525
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: