Provider Demographics
NPI:1205127693
Name:PAN AMERICAN MOA FOUNDATION INC
Entity type:Organization
Organization Name:PAN AMERICAN MOA FOUNDATION INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR/PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:RON
Authorized Official - Middle Name:C
Authorized Official - Last Name:KATO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-574-9900
Mailing Address - Street 1:4533 S. CENTINELA AVENUE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90066-6249
Mailing Address - Country:US
Mailing Address - Phone:310-574-9900
Mailing Address - Fax:310-574-9901
Practice Address - Street 1:4533 S. CENTINELA AVENUE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90066-6249
Practice Address - Country:US
Practice Address - Phone:310-574-9900
Practice Address - Fax:310-574-9901
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-20
Last Update Date:2011-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA0002405889-0001-12083P0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive MedicineGroup - Single Specialty