Provider Demographics
NPI:1346434024
Name:SUDABEH MOEIN, MD,INC
Entity type:Organization
Organization Name:SUDABEH MOEIN, MD,INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SUDABEH
Authorized Official - Middle Name:
Authorized Official - Last Name:MOEIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:858-487-2877
Mailing Address - Street 1:15611 POMERADO RD
Mailing Address - Street 2:#505
Mailing Address - City:POWAY
Mailing Address - State:CA
Mailing Address - Zip Code:92064-2437
Mailing Address - Country:US
Mailing Address - Phone:858-487-2877
Mailing Address - Fax:858-487-0729
Practice Address - Street 1:15611 POMERADO RD
Practice Address - Street 2:#505
Practice Address - City:POWAY
Practice Address - State:CA
Practice Address - Zip Code:92064-2437
Practice Address - Country:US
Practice Address - Phone:858-487-2877
Practice Address - Fax:858-487-0729
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-05
Last Update Date:2010-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA67561207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A675610Medicaid
CAH54508Medicare UPIN
CA00A675610Medicaid