Individual
DR. ANOOSH MOADAB
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.P.M.
Contact information
Practice address
6115 N 1ST ST STE 101, FRESNO, CA 93710-5450
(559) 436-1213
(559) 436-4202
Mailing address
6115 N 1ST ST STE 101, FRESNO, CA 93710-5450
(559) 436-1213
(559) 436-4202
Taxonomy
Speciality
Code
Description
License number
State
213ES0103X
Foot & Ankle Surgery Podiatrist
Primary
E4514
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000E45140
—
CA
01
—
00E45140
BLUE SHIELD
CA
01
—
611685600
DEPARTMENT OF LABOR
—
01
—
E45140
BLUE CROSS
CA
Enumeration date
06/30/2005
Last updated
04/20/2012
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