Provider Demographics
NPI:1043240229
Name:MOYA, STEPHANIE ANNETTE (MD, RD)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:ANNETTE
Last Name:MOYA
Suffix:
Gender:F
Credentials:MD, RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:865 SILVER AVE SW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87102-3020
Mailing Address - Country:US
Mailing Address - Phone:480-703-7980
Mailing Address - Fax:
Practice Address - Street 1:1501 SAN PEDRO DR SE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87108-5153
Practice Address - Country:US
Practice Address - Phone:505-265-1711
Practice Address - Fax:505-256-5455
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-04
Last Update Date:2008-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ933782133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered