Provider Demographics
NPI:1972053247
Name:MOMA, JON M (ND)
Entity type:Individual
Prefix:DR
First Name:JON
Middle Name:M
Last Name:MOMA
Suffix:
Gender:M
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8759 E BELL RD BLDG G
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85260-1340
Mailing Address - Country:US
Mailing Address - Phone:602-569-4144
Mailing Address - Fax:602-569-4244
Practice Address - Street 1:8759 E BELL RD BLDG G
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85260-1340
Practice Address - Country:US
Practice Address - Phone:602-569-4144
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-10
Last Update Date:2023-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WANT.60681843175F00000X
AZ23-1767175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath