Chace Donovyne Ikaika Moleta, MD

Primary specialty

Anatomic Pathology & Clinical Pathology PhysicianTaxonomy code 207ZP0102X

License

A166812 Issued in CA

Practice address

9500 Gilman Dr
La Jolla, CA 92093-5004

Phone

(619) 543-8254

NPI assigned

Apr 3, 2018

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Medicine

State licenses

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

{
    "created_epoch": "1522713600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1655769600000",
    "number": "1508362971",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5865 FRIARS RD APT 3217",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921106020",
            "telephone_number": "808-782-6489"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9500 GILMAN DR",
            "city": "LA JOLLA",
            "state": "CA",
            "postal_code": "920935004",
            "telephone_number": "619-543-8254"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOLETA",
        "first_name": "CHACE",
        "middle_name": "DONOVYNE IKAIKA",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-04-03",
        "last_updated": "2022-06-21",
        "certification_date": "2022-06-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207ZP0102X",
            "taxonomy_group": "",
            "desc": "Pathology, Anatomic Pathology & Clinical Pathology",
            "state": "CA",
            "license": "A166812",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Saara Anjum Mohammed, MD
• Rajeev Chandra Mohan, MD
• William C Mohlenbrock, MD
• Darush Lawrence Mohyi, M.D.
• Jennifer Moitoza Johnson, M.D.
• Gaston R. Molina Jr., M.D.
• Mariam Mahmoud Momani, PHARMD
• Molly Latta Monahan, PA-C
• Nisha N Money, MD
• Nattaporn Mongkolkeha

• Anatomic Pathology & Clinical Pathology Physician in La Jolla, CA
• Providers in La Jolla, CA by specialty
• Anatomic Pathology & Clinical Pathology Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.