Moothedath a Menon

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

License

A41105 Issued in CA

Legal business name

MOOTHEDATH A MENON

Practice address

18056 Wika Rd
Suite a
Apple Valley, CA 92307-2125

Phone

(760) 242-1090

Fax

(760) 247-1415

NPI assigned

Jul 19, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Moothedath A Menon, MD

Title

Physician

Phone

(760) 242-1090

Specialties & licenses 1

Addresses

Other names 1

• Wika Endoscopy Center Doing business as

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Ambulatory surgical center certification: CCN 05C0001375

Legal name

Wika Endoscopy Center

Certification status

Active

Provider type (POS)

Ambulatory surgical center

Participating since

Feb 27, 1997

Last certification

Jun 26, 2019

Ownership / control type

Proprietary

Facility address

18056 Wika Rd, Suite D
Apple Valley, CA 92307

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1153267200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1224028800000",
    "number": "1477572675",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "18056 WIKA RD",
            "address_2": "SUITE A",
            "city": "APPLE VALLEY",
            "state": "CA",
            "postal_code": "923072125",
            "telephone_number": "760-242-1090",
            "fax_number": "760-247-1415"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "18056 WIKA RD",
            "address_2": "SUITE A",
            "city": "APPLE VALLEY",
            "state": "CA",
            "postal_code": "923072125",
            "telephone_number": "760-242-1090",
            "fax_number": "760-247-1415"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MOOTHEDATH A MENON",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-19",
        "last_updated": "2008-10-15",
        "status": "A",
        "authorized_official_last_name": "MENON",
        "authorized_official_first_name": "MOOTHEDATH",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "PHYSICIAN",
        "authorized_official_telephone_number": "760-242-1090",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "CA",
            "license": "A41105",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Wika Endoscopy Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Autumn Caylee Moore
• Kaylynn Moore
• Malik Moore
• Porchia Moore
• Shynette Moore
• Moqattash Medical Group Inc
• Leonardo Moqattash, M.D.
• Tarek Moqattash, M.D.
• Andrew E Mora
• Lizette Morales Garcia

• Ambulatory Surgical Clinic/Center in Apple Valley, CA
• Providers in Apple Valley, CA by specialty
• Ambulatory Surgical Clinic/Center in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 15, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.