Provider Demographics
NPI:1871868299
Name:RHEUMATOLOGY ASSOCIATES OF SOUTHERN CALIFORNIA
Entity type:Organization
Organization Name:RHEUMATOLOGY ASSOCIATES OF SOUTHERN CALIFORNIA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:AMIR
Authorized Official - Middle Name:
Authorized Official - Last Name:MOLDOVAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:661-505-9901
Mailing Address - Street 1:23206 LYONS AVENUE
Mailing Address - Street 2:SUITE 106
Mailing Address - City:SANTA CLARITA
Mailing Address - State:CA
Mailing Address - Zip Code:91321-2671
Mailing Address - Country:US
Mailing Address - Phone:661-505-9901
Mailing Address - Fax:661-505-9902
Practice Address - Street 1:23206 LYONS AVENUE
Practice Address - Street 2:SUITE 106
Practice Address - City:SANTA CLARITA
Practice Address - State:CA
Practice Address - Zip Code:91321-2671
Practice Address - Country:US
Practice Address - Phone:661-505-9901
Practice Address - Fax:661-505-9902
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-19
Last Update Date:2013-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGC956AOtherMEDICARE PTAN