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General NPI Number Information
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NPI Number | 1346434024
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Entity Type | Organization
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Legal Business Name | SUDABEH MOEIN, MD,INC
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Dates
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Enumeration Date | 09/05/2007
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Last Update Date | 03/03/2010
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Provider Practice Location Address
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Address Line | 15611 POMERADO RD #505
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City | POWAY
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State | CA
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Zip | 92064-2437
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Country | US
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Telephone | 858-487-2877
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Fax | 858-487-0729
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Provider Business Mailing Address
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Address Line | 15611 POMERADO RD #505
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City | POWAY
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State | CA
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Zip | 92064-2437
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Country | US
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Telephone | 858-487-2877
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Fax | 858-487-0729
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Authorized Official
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Title or Position | OWNER
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Name | SUDABEH MOEIN
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Credential | M.D.
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Telephone | 858-487-2877
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207VG0400X
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Taxonomy Name | Gynecology Physician
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License Number | A67561
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License Number State | CA
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