Healthcare Provider Details

I. General information

NPI: 1932427796
Provider Name (Legal Business Name): MELANIE T. MOYA FAMILY NURSE PRACTIT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2010
Last Update Date: 05/04/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4650 SUNSET BOULEVARD CHILDRENS HOSPITAL LOS ANGELES
LOS ANGELES CA
90027
US

IV. Provider business mailing address

4650 SUNSET BOULEVARD MAIL STOP, #125 CHILDRENS HOSPITAL LOS ANGELES
LOS ANGELES CA
90027-0980
US

V. Phone/Fax

Practice location:
  • Phone: 323-361-2533
  • Fax:
Mailing address:
  • Phone: 323-361-2533
  • Fax: 323-361-8095

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN#437641
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: