MOOTHEDATH A MENON NPI 1477572675

NPI Information

NPI: 1477572675
Provider Name: MOOTHEDATH A MENON

Doing Business As: WIKA ENDOSCOPY CENTER

Classification: Clinic/Center - 261QA1903X
Entity Type: Organization

Specialization: Ambulatory Surgical

Address:
18056 WIKA RD
SUITE A
APPLE VALLEY, CA
ZIP 92307
Phone: (760) 242-1090
Get Directions

MOOTHEDATH A MENON is an ambulatory surgical clinic center in Apple Valley, CA. MOOTHEDATH A MENON NPI is 1477572675. The provider is registered as an organization entity type.
The provider Is Doing Business As Wika Endoscopy Center.

The provider's business location address is:

18056 WIKA RD
SUITE A
APPLE VALLEY, CA
ZIP 92307-125
Phone: (760) 242-1090
Fax: (760) 247-1415

The provider's authorized official is Moothedath A Menon .
The authorized official title is Physician and has the following contact phone number (760) 242-1090.

The enumeration date for this NPI number is 7/19/2006 and was last updated on 10/15/2008.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	261QA1903X	Clinic/Center	Ambulatory Surgical	A41105	CALIFORNIA	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	ZZZ13561Z	MEDICARE ID-TYPE UNSPECIFIED	CALIFORNIA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

NPI Synchronization or Removal

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