Individual
DR. MICHAEL MOON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
5348 CARROLL CANYON RD, SUITE 101, SAN DIEGO, CA 92121-1733
(858) 202-1546
(858) 202-1548
Mailing address
5348 CARROLL CANYON RD, SUITE 101, SAN DIEGO, CA 92121-1733
(858) 202-1546
(858) 202-1548
Taxonomy
Speciality
Code
Description
License number
State
208VP0014X
Interventional Pain Medicine Physician
Primary
A61865
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
127169100
ACS-US DEPT OF LABOR
CA
01
—
330992123
BLUE CROSS
CA
01
—
A61865
LICENSE NUMBER
CA
05
—
GR0096070
—
CA
01
—
P00302519
RAIL ROAD MEDICARE
CA
01
—
ZZZ07215Z
BLUE SHIELD
CA
Enumeration date
01/31/2007
Last updated
09/24/2012
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