Provider Demographics
NPI:1295772507
Name:MOON, ROBERT H (MD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:H
Last Name:MOON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:1030 WHITE ALDER AVE
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91914-2611
Mailing Address - Country:US
Mailing Address - Phone:619-800-6713
Mailing Address - Fax:619-503-9000
Practice Address - Street 1:1030 WHITE ALDER AVE
Practice Address - Street 2:
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91914-2611
Practice Address - Country:US
Practice Address - Phone:619-800-6713
Practice Address - Fax:619-503-9000
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-02
Last Update Date:2023-03-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA76947207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A769470Medicaid
CAWA76847CMedicare PIN
CA00A769470Medicaid