Provider Demographics
NPI:1912626300
Name:MOYA, ERIC FELIPE (EDS)
Entity Type:Individual
Prefix:MR
First Name:ERIC
Middle Name:FELIPE
Last Name:MOYA
Suffix:
Gender:M
Credentials:EDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9539 OLNEY ST
Mailing Address - Street 2:
Mailing Address - City:ROSEMEAD
Mailing Address - State:CA
Mailing Address - Zip Code:91770-2168
Mailing Address - Country:US
Mailing Address - Phone:626-329-9060
Mailing Address - Fax:
Practice Address - Street 1:4515 ENCINITA AVE
Practice Address - Street 2:
Practice Address - City:ROSEMEAD
Practice Address - State:CA
Practice Address - Zip Code:91770-1486
Practice Address - Country:US
Practice Address - Phone:626-286-3155
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-26
Last Update Date:2022-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool