Organization
MOOTHEDATH A MENON
Active
Other names
Wika Endoscopy Center
Organization subpart
No
Provider details
NPI number
Authorized official
MOOTHEDATH A MENON MD (PHYSICIAN)
(760) 242-1090
Entity
Organization
Contact information
Practice address
18056 WIKA RD, SUITE A, APPLE VALLEY, CA 92307-2125
(760) 242-1090
(760) 247-1415
Mailing address
18056 WIKA RD, SUITE A, APPLE VALLEY, CA 92307-2125
(760) 242-1090
(760) 247-1415
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
A41105
CA
Other
Enumeration date
07/19/2006
Last updated
10/15/2008
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