Provider Demographics
NPI:1245291624
Name:MOLDOVAN, STEFAN (MD)
Entity type:Individual
Prefix:DR
First Name:STEFAN
Middle Name:
Last Name:MOLDOVAN
Suffix:
Gender:M
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:PO BOX 462079
Mailing Address - Street 2:
Mailing Address - City:ESCONDIDO
Mailing Address - State:CA
Mailing Address - Zip Code:92046-2079
Mailing Address - Country:US
Mailing Address - Phone:760-739-7666
Mailing Address - Fax:760-739-7633
Practice Address - Street 1:625 W CITRACADO PKWY
Practice Address - Street 2:SUITE 203
Practice Address - City:ESCONDIDO
Practice Address - State:CA
Practice Address - Zip Code:92025-6428
Practice Address - Country:US
Practice Address - Phone:760-739-7666
Practice Address - Fax:760-739-7633
Is Sole Proprietor?:No
Enumeration Date:2006-03-28
Last Update Date:2010-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA56200208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A562000Medicaid
CAWA56200BMedicare PIN
CAWA56200CMedicare PIN
CAWA56200AMedicare PIN
CAWA56200DMedicare PIN
P00393227Medicare PIN
CA00A562000Medicaid