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NPI Code Detail

MEDICARE: DR. DAWNELL JEAN MOODY D.O.

MEDICARE: DR. DAWNELL JEAN MOODY D.O.
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
1208000000XPediatrics Physician20A10486CA

General Provider Information

NPI Number : 1144431750
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. DAWNELL JEAN MOODY D.O.
Provider Business Mailing Address
First Line : 4361 RAILROAD AVE
Second Line :
City : PLEASANTON
State : CA
Zip : 94566-6611
Country : US
Telephone Number : 925-462-1755
Fax Number : 925-462-1650
Provider Business Practice Location Address
First Line : 5925 W LAS POSITAS BLVD
Second Line :
City : PLEASANTON
State : CA
Zip : 94588-8537
Country : US
Telephone Number : 925-462-1755
Fax Number : 925-417-1503
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/24/2007
Last Update Date : 07/21/2022

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