Provider Demographics
NPI:1538153747
Name:MOITOZA, JAMES RAYMOND (MD)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:RAYMOND
Last Name:MOITOZA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:4510 EXECUTIVE DR
Mailing Address - Street 2:SUITE 125
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92121-3021
Mailing Address - Country:US
Mailing Address - Phone:858-666-7047
Mailing Address - Fax:858-643-5660
Practice Address - Street 1:4510 EXECUTIVE DR
Practice Address - Street 2:SUITE 125
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92121-3021
Practice Address - Country:US
Practice Address - Phone:858-666-7047
Practice Address - Fax:858-643-5660
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-01
Last Update Date:2018-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMD19645207X00000X
CAG35078207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAOOG350780Medicaid
CAW14861Medicare ID - Type UnspecifiedMEDICARE
CAOOG350780Medicaid