Provider Demographics
NPI:1386915072
Name:P.A.MOYA CSFA, LLC
Entity type:Organization
Organization Name:P.A.MOYA CSFA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CSFA
Authorized Official - Prefix:MR
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:MOYA
Authorized Official - Suffix:
Authorized Official - Credentials:CSFA
Authorized Official - Phone:817-485-6550
Mailing Address - Street 1:7401 QUAIL CT
Mailing Address - Street 2:
Mailing Address - City:WATAUGA
Mailing Address - State:TX
Mailing Address - Zip Code:76148-1639
Mailing Address - Country:US
Mailing Address - Phone:817-485-6550
Mailing Address - Fax:817-581-8925
Practice Address - Street 1:7401 QUAIL CT
Practice Address - Street 2:
Practice Address - City:WATAUGA
Practice Address - State:TX
Practice Address - Zip Code:76148-1639
Practice Address - Country:US
Practice Address - Phone:817-485-6550
Practice Address - Fax:817-581-8925
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-26
Last Update Date:2012-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1942455365OtherINDIVIDUAL NPI