Healthcare Provider Details

I. General information

NPI: 1508053919
Provider Name (Legal Business Name): DIANA J MOYA R.PH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/29/2007
Last Update Date: 10/22/2024
Certification Date: 10/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

606 ARMENTA ST
SANTA FE NM
87505-0319
US

IV. Provider business mailing address

606 ARMENTA ST
SANTA FE NM
87505-0319
US

V. Phone/Fax

Practice location:
  • Phone: 505-982-8269
  • Fax:
Mailing address:
  • Phone: 505-982-8269
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License NumberRP4953
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP4953
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: