Basic Information
| Provider Information | |||||||||
| NPI: | 1023339413 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MOYNIHAN | ||||||||
| FirstName: | CLARE | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 742244 | ||||||||
| Address2: | |||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900742244 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 5800 HOLLIS ST | ||||||||
| Address2: | |||||||||
| City: | EMERYVILLE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 946082016 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5108062100 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/20/2010 | ||||||||
| LastUpdateDate: | 04/08/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 2012016765 | MO | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207RE0101X | 2012016765 | MO | N | Allopathic & Osteopathic Physicians | Internal Medicine | Endocrinology, Diabetes & Metabolism | 207RE0101X | 137429 | CA | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Endocrinology, Diabetes & Metabolism |
No ID Information.