Provider Demographics
NPI:1437180791
Name:MOYER, TRENTON ELIOT (MD)
Entity Type:Individual
Prefix:DR
First Name:TRENTON
Middle Name:ELIOT
Last Name:MOYER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:3252 HOLIDAY CT
Mailing Address - Street 2:103
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92037-0027
Mailing Address - Country:US
Mailing Address - Phone:866-284-2771
Mailing Address - Fax:858-578-0858
Practice Address - Street 1:3252 HOLIDAY CT
Practice Address - Street 2:103
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92037-0027
Practice Address - Country:US
Practice Address - Phone:866-284-2771
Practice Address - Fax:858-578-0858
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2019-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA781652084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAI05610Medicare UPIN