Provider Demographics
NPI:1134456627
Name:FEMALE PELVIC MEDICINE AND RECONSTRUCTIVE SURGERY OF THE HIGH DESERT
Entity Type:Organization
Organization Name:FEMALE PELVIC MEDICINE AND RECONSTRUCTIVE SURGERY OF THE HIGH DESERT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MOSES
Authorized Official - Middle Name:T
Authorized Official - Last Name:MUKAI
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:760-946-5177
Mailing Address - Street 1:19333 BEAR VALLEY ROAD
Mailing Address - Street 2:SUITE 106
Mailing Address - City:APPLE VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92308-0000
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:19333 BEAR VALLEY RD
Practice Address - Street 2:SUITE 106
Practice Address - City:APPLE VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92308-5148
Practice Address - Country:US
Practice Address - Phone:760-946-5177
Practice Address - Fax:760-946-5133
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-04
Last Update Date:2010-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A5527207VG0400X, 208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Multi-Specialty
No208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Multi-Specialty