Individual
MOOTHEDATH A MENON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
661 W 1ST ST STE G, TUSTIN, CA 92780-2939
(714) 665-9890
(714) 665-9891
Mailing address
661 W 1ST ST STE G, TUSTIN, CA 92780-2939
(714) 665-9890
(714) 665-9891
Taxonomy
Speciality
Code
Description
License number
State
207RG0100X
Gastroenterology Physician
Primary
A41105
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00A411050
—
CA
Enumeration date
09/19/2005
Last updated
10/22/2025
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