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Individual
LANNIE MOY
Active
Individual
LANNIE MOY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
PA10717
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
EFF: 2/21/13 RIALTO
—
CA
05
—
EFF: 2/21/13- S BERN
—
CA
05
—
EFF:2/21/13 FONTANA
—
CA
05
—
PA10717
—
CA
01
—
PA107170
MEDI CAL
—
Enumeration date
07/02/2006
Last updated
09/23/2013
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