Healthcare Provider Details

I. General information

NPI: 1114727773
Provider Name (Legal Business Name): MOYA INNOVATIVE VASCULAR SERVICES PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/13/2025
Last Update Date: 03/13/2025
Certification Date: 03/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 NORTHGATE LN
MCALLEN TX
78504-9558
US

IV. Provider business mailing address

1400 NORTHGATE LN
MCALLEN TX
78504-9558
US

V. Phone/Fax

Practice location:
  • Phone: 610-908-2995
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. MARIO MOYA
Title or Position: CEO
Credential: MD
Phone: 610-908-2995