| Sudha Moola Md Inc | |
|
3975 Jackson St 208 Riverside CA 92503-3901 | |
| (951) 732-7834 | |
| (951) 352-7758 |
| Full Name | Sudha Moola Md Inc |
|---|---|
| Speciality | Obstetrics & Gynecology |
| Location | 3975 Jackson St, Riverside, California |
| Authorized Official Name and Position | Sudha Moola (PRESIDENT) |
| Authorized Official Contact | 9517327834 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Sudha Moola Md Inc 1240 Las Ventanas Way Riverside CA 92508-8722 Ph: (951) 732-7834 | Sudha Moola Md Inc 3975 Jackson St 208 Riverside CA 92503-3901 Ph: (951) 732-7834 |
| NPI Number | 1427318781 |
|---|---|
| Provider Enumeration Date | 05/21/2012 |
| Last Update Date | 05/30/2012 |
| Medicare PECOS PAC ID | 0941533244 |
|---|---|
| Medicare Enrollment ID | O20190530002950 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1427318781 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | A101361 (California) | Secondary |
| 207V00000X | Obstetrics & Gynecology | A101361 (California) | Primary |
| Provider Name | Sudha Moola |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1063628386 PECOS PAC ID: 0446307474 Enrollment ID: I20090409000157 |
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