Healthcare Provider Details

I. General information

NPI: 1154143691
Provider Name (Legal Business Name): KIMBERLY MOYA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/28/2024
Last Update Date: 10/28/2024
Certification Date: 10/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

410 E MERCED AVE STE E
WEST COVINA CA
91790-5058
US

IV. Provider business mailing address

9523 OLNEY ST
ROSEMEAD CA
91770-2150
US

V. Phone/Fax

Practice location:
  • Phone: 323-426-6402
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: