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General NPI Number Information
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NPI Number | 1386915072
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Entity Type | Organization
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Legal Business Name | P.A.MOYA CSFA, LLC
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Dates
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Enumeration Date | 01/26/2012
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Last Update Date | 01/26/2012
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Provider Practice Location Address
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Address Line | 7401 QUAIL CT
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City | WATAUGA
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State | TX
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Zip | 76148-1639
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Country | US
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Telephone | 817-485-6550
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Fax | 817-581-8925
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Provider Business Mailing Address
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Address Line | 7401 QUAIL CT
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City | WATAUGA
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State | TX
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Zip | 76148-1639
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Country | US
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Telephone | 817-485-6550
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Fax | 817-581-8925
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Authorized Official
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Title or Position | CSFA
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Name | MR. PATRICK ANTHONY MOYA
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Credential | CSFA
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Telephone | 817-485-6550
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number |
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License Number State |
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