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General NPI Number Information
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NPI Number | 1548351000
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Entity Type | Individual
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Provider Name | MARIE A. MOY D.O.
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Gender | Female
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Dates
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Enumeration Date | 09/27/2006
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Last Update Date | 02/12/2014
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Provider Practice Location Address
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Address Line | 1509 WILSON TERRACE
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City | GLENDALE
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State | CA
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Zip | 91206-4007
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Country | US
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Telephone | 818-409-8000
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Fax | 909-469-6741
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Provider Business Mailing Address
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Address Line | 2200 NORTH MAYFAIR ROAD SUITE 200
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City | WAUWATOSA
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State | WI
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Zip | 53226-2252
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Country | US
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Telephone | 414-258-9511
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Fax | 414-607-3946
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 20A7787
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License Number State | CA
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