Healthcare Provider Details

I. General information

NPI: 1831809623
Provider Name (Legal Business Name): NICOLE MOEMAI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/01/2022
Last Update Date: 12/11/2025
Certification Date: 12/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3462 S HAWK DR
SARATOGA SPRINGS UT
84045-6016
US

IV. Provider business mailing address

3462 S HAWK DR
SARATOGA SPRINGS UT
84045-6016
US

V. Phone/Fax

Practice location:
  • Phone: 951-396-5540
  • Fax:
Mailing address:
  • Phone: 951-396-5540
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VX0000X
TaxonomyObstetrics Physician
License Number14197524-3400
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: