MEDICARE: MS. NOELENE S MOONSAMY FNP-C

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	363LF0000X	Family Nurse Practitioner	597031	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	597031	OTHER	CA	NP LICENSE CA

General Provider Information

NPI Number	:	1932481603
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. NOELENE S MOONSAMY FNP-C

Provider Business Mailing Address
First Line	:	4959 STONERIDGE CT
Second Line	:
City	:	OAKLAND
State	:	CA
Zip	:	94605-3872
Country	:	US
Telephone Number	:	510-432-7460
Fax Number	:

Provider Business Practice Location Address
First Line	:	1050 MARINA VILLAGE PKWY STE 101
Second Line	:
City	:	ALAMEDA
State	:	CA
Zip	:	94501-1033
Country	:	US
Telephone Number	:	725-527-2897
Fax Number	:

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

Provider Enumeration Date	:	09/19/2011
Last Update Date	:	01/28/2022

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