Healthcare Provider Details

I. General information

NPI: 1154376101
Provider Name (Legal Business Name): RENATA MILENA STOSZEK MOON M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2006
Last Update Date: 12/08/2022
Certification Date: 12/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

322 W NORTH RIVER DR
SPOKANE WA
99201-3208
US

IV. Provider business mailing address

6451 N FEDERAL HWY
FORT LAUDERDALE FL
33308-1402
US

V. Phone/Fax

Practice location:
  • Phone: 509-324-6464
  • Fax:
Mailing address:
  • Phone: 877-336-6077
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME154557
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD00043974
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: