Provider Demographics
NPI:1679320923
Name:MOYA, ADDI NICOLAS (MD)
Entity type:Individual
Prefix:
First Name:ADDI
Middle Name:NICOLAS
Last Name:MOYA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 650859
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75265-0859
Mailing Address - Country:US
Mailing Address - Phone:409-772-8119
Mailing Address - Fax:409-772-1872
Practice Address - Street 1:301 UNIVERSITY BLVD
Practice Address - Street 2:
Practice Address - City:GALVESTON
Practice Address - State:TX
Practice Address - Zip Code:77555-0724
Practice Address - Country:US
Practice Address - Phone:409-772-8119
Practice Address - Fax:409-772-1872
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-03
Last Update Date:2024-05-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXBP100899922086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery