Provider Demographics
NPI:1770699571
Name:MOON, STEVE F (BSC KIN, CWCE, CELE)
Entity type:Individual
Prefix:MR
First Name:STEVE
Middle Name:F
Last Name:MOON
Suffix:
Gender:M
Credentials:BSC KIN, CWCE, CELE
Other - Prefix:MR
Other - First Name:STEVE
Other - Middle Name:F
Other - Last Name:MOON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:BSC KIN CWCE, CELE
Mailing Address - Street 1:2224 SPYGLASS DR
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:94513-5672
Mailing Address - Country:US
Mailing Address - Phone:925-858-6323
Mailing Address - Fax:925-513-8792
Practice Address - Street 1:2420 SAND CREEK RD # C1-303
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:CA
Practice Address - Zip Code:94513-2707
Practice Address - Country:US
Practice Address - Phone:925-858-6323
Practice Address - Fax:925-513-8792
Is Sole Proprietor?:No
Enumeration Date:2006-08-22
Last Update Date:2020-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
710965035OtherIRS