Provider Demographics
NPI:1679300321
Name:CLAUDIO-HENRIQUEZ, MOISES A
Entity type:Individual
Prefix:
First Name:MOISES
Middle Name:A
Last Name:CLAUDIO-HENRIQUEZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4453 W 137TH ST
Mailing Address - Street 2:
Mailing Address - City:HAWTHORNE
Mailing Address - State:CA
Mailing Address - Zip Code:90250-6901
Mailing Address - Country:US
Mailing Address - Phone:310-465-8479
Mailing Address - Fax:
Practice Address - Street 1:4453 W 137TH ST
Practice Address - Street 2:
Practice Address - City:HAWTHORNE
Practice Address - State:CA
Practice Address - Zip Code:90250-6901
Practice Address - Country:US
Practice Address - Phone:310-465-8479
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-17
Last Update Date:2025-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA65430207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine