MEDICARE: MOON MOUNTAIN FAMILY MEDICINE INCORPORATED

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	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1346189669
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MOON MOUNTAIN FAMILY MEDICINE INCORPORATED

Provider Business Mailing Address
First Line	:	258 E 10TH AVE STE 103
Second Line	:
City	:	EUGENE
State	:	OR
Zip	:	97401-3255
Country	:	US
Telephone Number	:	541-224-8283
Fax Number	:

Provider Business Practice Location Address
First Line	:	258 E 10TH AVE STE 103
Second Line	:
City	:	EUGENE
State	:	OR
Zip	:	97401-3255
Country	:	US
Telephone Number	:	541-224-8283
Fax Number	:

Authorized Official
Title or Position	:	OWNER/PROVIDER
Name	:	AMANDA DAVALOS
Credential	:	FNP
Telephone Number	:	541-224-8283

Provider Enumeration Date	:	03/25/2026
Last Update Date	:	03/25/2026

Similar Medicare Providers

1740939297 — MATTIE ROSE MCCLASKEY MA
Practice Location Address:

258 E 10TH AVE
EUGENE, OR
97401-3255

Practice Phone: 541-255-4981
Practice Fax:

1720934896 — AUDACIOUS LIVING THERAPY LLC
Practice Location Address:

258 E 10TH AVE
EUGENE, OR
97401-3255

Practice Phone: 542-913-1153
Practice Fax:

1629066246 — ALL-MED, INC.
Practice Location Address:

925 RIVER RD
EUGENE, OR
97404-3255

Practice Phone: 541-485-3411
Practice Fax: 541-485-4076

1972056562 — DR. THOMAS BOSCH PHD, RDN, LDN
Practice Location Address:

2455 FIELDCRESS RD
EUGENE, OR
97403-3255

Practice Phone: 541-505-7758
Practice Fax: 541-505-7758

1568910321 — BOSCH NUTRITION LLC
Practice Location Address:

2455 FIELDCRESS RD
EUGENE, OR
97403-3255

Practice Phone: 541-505-7758
Practice Fax:

1699890764 — MS. NANCY MAY DEJESUS
Practice Location Address:

2145 CENTENNIAL PLZ
EUGENE, OR
97401-2421

Practice Phone: 541-684-5825
Practice Fax: 541-684-6826

Directions to “MOON MOUNTAIN FAMILY MEDICINE INCORPORATED ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.