MEDICARE: MOA FAMILY CARE

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	225400000X	Rehabilitation Practitioner

General Provider Information

NPI Number	:	1932457629
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MOA FAMILY CARE

Provider Business Mailing Address
First Line	:	6561 JENNY LAKE AVENUE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89110
Country	:	US
Telephone Number	:	702-505-1208
Fax Number	:

Provider Business Practice Location Address
First Line	:	6561 JENNY LAKE AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89110-4010
Country	:	US
Telephone Number	:	702-505-1208
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	ANNA LIZETTE ANGAT
Credential	:
Telephone Number	:	702-505-1208

Provider Enumeration Date	:	08/28/2012
Last Update Date	:	08/28/2012

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