Healthcare Provider Details

I. General information

NPI: 1891703989
Provider Name (Legal Business Name): JAIME MOY DO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/04/2006
Last Update Date: 11/10/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2219 E 1ST ST
LOS ANGELES CA
90033-3901
US

IV. Provider business mailing address

10418 VALLEY BLVD STE B
EL MONTE CA
91731-3600
US

V. Phone/Fax

Practice location:
  • Phone: 323-269-0421
  • Fax: 323-780-9432
Mailing address:
  • Phone: 626-453-8466
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number20A8734
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: