Provider Demographics
NPI:1184069148
Name:SUNITA MOOLA MD INC
Entity type:Organization
Organization Name:SUNITA MOOLA MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:SUNITA
Authorized Official - Middle Name:
Authorized Official - Last Name:MOOLA
Authorized Official - Suffix:
Authorized Official - Credentials:MD,
Authorized Official - Phone:949-910-1064
Mailing Address - Street 1:18 CALAVERA
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92606-8923
Mailing Address - Country:US
Mailing Address - Phone:949-910-1064
Mailing Address - Fax:
Practice Address - Street 1:11100 WARNER AVE STE 150B
Practice Address - Street 2:
Practice Address - City:FOUNTAIN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92708-7510
Practice Address - Country:US
Practice Address - Phone:714-456-6600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-03
Last Update Date:2025-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA106895207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX220421601Medicaid
1770770695OtherNPI - INDIVIDUAL
1770770695OtherNPI - INDIVIDUAL