Healthcare Provider Details

I. General information

NPI: 1407463581
Provider Name (Legal Business Name): ALICE MOYO FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/23/2020
Last Update Date: 04/11/2025
Certification Date: 04/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14457 ROSCOE BLVD
PANORAMA CITY CA
91402-3012
US

IV. Provider business mailing address

14457 ROSCOE BLVD
PANORAMA CITY CA
91402-3012
US

V. Phone/Fax

Practice location:
  • Phone: 818-810-5947
  • Fax:
Mailing address:
  • Phone: 818-810-5947
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number06200350
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: