NPIMap

Organization Active NPI

St Mary Specialty Clinic

  • Obstetrics & Gynecology Physician
  • Apple Valley, CA
National Provider Identifier
1588972806
Registry record updated May 31, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X
Legal business name
ST MARY SPECIALTY CLINIC
Practice address
19333 Bear Valley Rd Ste 106
Apple Valley, CA 92308-5149
Phone
(760) 240-5505
Fax
(760) 240-5525
NPI assigned
Sep 21, 2010
Last updated
May 31, 2013By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 31, 2013

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

Authorized official

Name
Dr. Moses T Mukai Jr., M.D.NPI 1629260948
Title
President
Phone
(714) 449-4800

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Obstetrics & Gynecology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207V00000X Primary
Surgery PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208600000X

Addresses

Primary practice location

19333 Bear Valley Rd Ste 106
Apple Valley, CA 92308-5149

Mailing address

Dept la 21190
Pasadena, CA 91185-1190
Phone (714) 449-4800

National Provider Directory

National Provider Directory

Locations

19333 Bear Valley Rd
Apple Valley, CA 92308
Phone (760) 240-3784

19341 Bear Valley Rd
Apple Valley, CA 92308

17073 Main St
Hesperia, CA 92345
Phone (760) 956-4121

17083 Main St
Hesperia, CA 92345

12550 Hesperia Rd
Ste 110
Victorville, CA 92395

Practitioners & affiliated clinicians

Practitioners 22

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 22

NPI Registry JSON

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

{
    "created_epoch": "1285027200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1369958400000",
    "number": "1588972806",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "DEPT LA 21190",
            "city": "PASADENA",
            "state": "CA",
            "postal_code": "911851190",
            "telephone_number": "714-449-4800",
            "fax_number": "714-449-4956"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "19333 BEAR VALLEY RD STE 106",
            "city": "APPLE VALLEY",
            "state": "CA",
            "postal_code": "923085149",
            "telephone_number": "760-240-5505",
            "fax_number": "760-240-5525"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST MARY SPECIALTY CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-09-21",
        "last_updated": "2013-05-31",
        "status": "A",
        "authorized_official_last_name": "MUKAI",
        "authorized_official_first_name": "MOSES",
        "authorized_official_middle_name": "T",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "714-449-4800",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_name_suffix": "Jr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Obstetrics & Gynecology",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "208600000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Surgery",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Apple Valley, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 31, 2013; 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.