Healthcare Provider Details

I. General information

NPI: 1063173201
Provider Name (Legal Business Name): ELIZABETH MOYER PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/09/2022
Last Update Date: 12/30/2024
Certification Date: 12/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3100 TELEGRAPH AVE
OAKLAND CA
94609-3239
US

IV. Provider business mailing address

3100 TELEGRAPH AVE
OAKLAND CA
94609-3239
US

V. Phone/Fax

Practice location:
  • Phone: 510-879-9257
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number62377
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: