MEDICARE: ANTONIO MOYA MD, MPH

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	2084N0400X	Neurology Physician	A155525	CA

General Provider Information

NPI Number	:	1891106076
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANTONIO MOYA MD, MPH

Provider Business Mailing Address
First Line	:	1100 GLENDON AVE STE 900
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90024-3513
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1100 GLENDON AVE STE 900
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90024-3513
Country	:	US
Telephone Number	:	310-794-2268
Fax Number	:

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

Provider Enumeration Date	:	05/09/2014
Last Update Date	:	05/20/2020

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