Healthcare Provider Details

I. General information

NPI: 1881012946
Provider Name (Legal Business Name): PETER MOVILLA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/04/2014
Last Update Date: 08/25/2020
Certification Date: 08/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

UK WOMEN'S HEALTH OBSTETRICS AND GYNECOLOGY 125 E MAXWELL ST STE 140
LEXINGTON KY
40508
US

IV. Provider business mailing address

631 DIAMOND ST
SAN FRANCISCO CA
94114-3225
US

V. Phone/Fax

Practice location:
  • Phone: 859-323-0005
  • Fax:
Mailing address:
  • Phone: 862-249-2711
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207VX0000X
TaxonomyObstetrics Physician
License Number141795
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberTP471
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: