Provider Demographics
NPI:1043723562
Name:MOQATTASH MEDICAL GROUP INC
Entity type:Organization
Organization Name:MOQATTASH MEDICAL GROUP INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LEONARDO
Authorized Official - Middle Name:
Authorized Official - Last Name:MOQATTASH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:909-894-6737
Mailing Address - Street 1:PO BOX 1927
Mailing Address - Street 2:
Mailing Address - City:VICTORVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:92393-1927
Mailing Address - Country:US
Mailing Address - Phone:760-906-9362
Mailing Address - Fax:760-503-0064
Practice Address - Street 1:15982 QUANTICO RD STE E
Practice Address - Street 2:
Practice Address - City:APPLE VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92307-1382
Practice Address - Country:US
Practice Address - Phone:760-906-9362
Practice Address - Fax:760-503-0064
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-06
Last Update Date:2024-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty