Provider Demographics
NPI:1154542538
Name:MOSES J. FALLAS, M.D. A MEDICAL CORPORATION
Entity type:Organization
Organization Name:MOSES J. FALLAS, M.D. A MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:PAM
Authorized Official - Middle Name:
Authorized Official - Last Name:CALDERON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-356-8303
Mailing Address - Street 1:9001 WILSHIRE BLVD STE 304
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90211-1840
Mailing Address - Country:US
Mailing Address - Phone:310-855-1023
Mailing Address - Fax:
Practice Address - Street 1:9001 WILSHIRE BLVD STE 304
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90211-1840
Practice Address - Country:US
Practice Address - Phone:310-855-1023
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-01
Last Update Date:2010-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG60106Medicare ID - Type Unspecified