MEDICARE: FEMALE PELVIC MEDICINE AND RECONSTRUCTIVE SURGERY OF THE HIGH DESERT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208800000X	Urology Physician	20A5527	CA
2	207VG0400X	Gynecology Physician	20A5527	CA

General Provider Information

NPI Number	:	1134456627
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FEMALE PELVIC MEDICINE AND RECONSTRUCTIVE SURGERY OF THE HIGH DESERT

Provider Business Mailing Address
First Line	:	19333 BEAR VALLEY ROAD
Second Line	:	SUITE 106
City	:	APPLE VALLEY
State	:	CA
Zip	:	92308-0000
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	19333 BEAR VALLEY RD
Second Line	:	SUITE 106
City	:	APPLE VALLEY
State	:	CA
Zip	:	92308-5148
Country	:	US
Telephone Number	:	760-946-5177
Fax Number	:	760-946-5133

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. MOSES T MUKAI
Credential	:	D.O.
Telephone Number	:	760-946-5177

Provider Enumeration Date	:	11/04/2009
Last Update Date	:	03/30/2010

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