Healthcare Provider Details

I. General information

NPI: 1891202198
Provider Name (Legal Business Name): HUMBERTO BENJAMIN MOYA SOCIAL WORKER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/08/2018
Last Update Date: 01/08/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26520 CACTUS AVE
MORENO VALLEY CA
92555-3927
US

IV. Provider business mailing address

843 SAINT VINCENT
IRVINE CA
92618-6915
US

V. Phone/Fax

Practice location:
  • Phone: 951-486-4000
  • Fax: 951-486-5211
Mailing address:
  • Phone: 714-376-3444
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: