Provider Demographics
NPI:1740201557
Name:MOLDOVAN, IOANA (MD)
Entity Type:Individual
Prefix:
First Name:IOANA
Middle Name:
Last Name:MOLDOVAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29297 CLEAR SPRING LN
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND
Mailing Address - State:CA
Mailing Address - Zip Code:92346-6201
Mailing Address - Country:US
Mailing Address - Phone:909-362-0964
Mailing Address - Fax:
Practice Address - Street 1:374 E VANDERBILT WAY
Practice Address - Street 2:
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92408-3593
Practice Address - Country:US
Practice Address - Phone:909-280-5557
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-21
Last Update Date:2021-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA86365207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A863650Medicaid
00A863650Medicare ID - Type Unspecified
CA00A863650Medicaid