Provider Demographics
NPI:1942455365
Name:MOYA, PATRICK ANTHONY (CST/CFA)
Entity Type:Individual
Prefix:MR
First Name:PATRICK
Middle Name:ANTHONY
Last Name:MOYA
Suffix:
Gender:M
Credentials:CST/CFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7401 QUAIL CT
Mailing Address - Street 2:
Mailing Address - City:WATAUGA
Mailing Address - State:TX
Mailing Address - Zip Code:76148-1639
Mailing Address - Country:US
Mailing Address - Phone:817-821-9727
Mailing Address - Fax:817-581-8925
Practice Address - Street 1:7401 QUAIL CT
Practice Address - Street 2:
Practice Address - City:WATAUGA
Practice Address - State:TX
Practice Address - Zip Code:76148-1639
Practice Address - Country:US
Practice Address - Phone:817-821-9727
Practice Address - Fax:817-581-8925
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-26
Last Update Date:2008-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX109042246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant