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15982 Quantico Rd Ste E Apple Valley CA 92307-1382 | |
(760) 906-9362 | |
(760) 503-0064 |
Full Name | |
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Speciality | Clinic/Center |
Location | 15982 Quantico Rd Ste E, Apple Valley, California |
Authorized Official Name and Position | Leonardo Moqattash (PRESIDENT) |
Authorized Official Contact | 9098946737 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Po Box 1927 Victorville CA 92393-1927 Ph: (760) 906-9362 | 15982 Quantico Rd Ste E Apple Valley CA 92307-1382 Ph: (760) 906-9362 |
NPI Number | 1043723562 |
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Provider Enumeration Date | 11/06/2017 |
Last Update Date | 06/12/2024 |
Medicare PECOS PAC ID | 2860935608 |
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Medicare Enrollment ID | O20240620002973 |
Identifier | Type | State | Issuer |
---|---|---|---|
1043723562 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207R00000X | Internal Medicine | (* (Not Available)) | Secondary |
261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Primary |
Provider Name | Leonardo S Moqattash |
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Provider Type | Practitioner - Internal Medicine |
Provider Identifiers | NPI Number: 1578982823 PECOS PAC ID: 2860763463 Enrollment ID: I20170731003244 |
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