Provider Demographics
NPI:1396973699
Name:MOYA, PAUL (DO)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:
Last Name:MOYA
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 S GRAND AVE
Mailing Address - Street 2:STE 415
Mailing Address - City:GLENDORA
Mailing Address - State:CA
Mailing Address - Zip Code:91741-4292
Mailing Address - Country:US
Mailing Address - Phone:626-335-3627
Mailing Address - Fax:626-335-4806
Practice Address - Street 1:210 S GRAND AVE
Practice Address - Street 2:STE 415
Practice Address - City:GLENDORA
Practice Address - State:CA
Practice Address - Zip Code:91741-4292
Practice Address - Country:US
Practice Address - Phone:626-335-3627
Practice Address - Fax:626-335-4806
Is Sole Proprietor?:No
Enumeration Date:2009-06-24
Last Update Date:2017-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A11804207Q00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine