Provider Demographics
NPI:1598023954
Name:MOON, RONALD LAVOR (CST/CSFA)
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:LAVOR
Last Name:MOON
Suffix:
Gender:M
Credentials:CST/CSFA
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Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:9806 RED DEER ST
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89143-1155
Mailing Address - Country:US
Mailing Address - Phone:702-985-8297
Mailing Address - Fax:
Practice Address - Street 1:9806 RED DEER ST
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89143
Practice Address - Country:US
Practice Address - Phone:702-985-8297
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-23
Last Update Date:2018-06-22
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical