MEDICARE: IVAN MOC

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	225100000X	Physical Therapist	309689	CA

General Provider Information

NPI Number	:	1225989312
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	IVAN MOC

Provider Business Mailing Address
First Line	:	5926 MONTEREY RD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90042-4943
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5926 MONTEREY RD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90042-4943
Country	:	US
Telephone Number	:	323-503-1414
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/05/2026
Last Update Date	:	02/05/2026

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Directions to “ IVAN MOC ” Practice Location

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