MEDICARE: MS. FABIOLA MOY MA CCC-SP

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	235Z00000X	Speech-Language Pathologist	SP8298	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0007707559	OTHER	CA	AETNA PIN

General Provider Information

NPI Number	:	1881844629
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. FABIOLA MOY MA CCC-SP

Provider Business Mailing Address
First Line	:	3816 WOODRUFF AVE STE 201
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90808-2145
Country	:	US
Telephone Number	:	562-260-8627
Fax Number	:

Provider Business Practice Location Address
First Line	:	3816 WOODRUFF AVE STE 201
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90808-2145
Country	:	US
Telephone Number	:	562-260-8627
Fax Number	:

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

Provider Enumeration Date	:	09/29/2008
Last Update Date	:	04/08/2014

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