Menon, Moothedath A
Menon, Moothedath A is an sole proprietor health care provider with primary practice located at 661 W 1St St Ste G , Tustin CA 92780-2939. He recently has only one registered license in Allopathic & Osteopathic Physicians / Gastroenterology, which is considered as his primary health care specialty. Menon, Moothedath A can be contacted via phone (714) 665-9890.Contact Information
Primary practice address
661 W 1St St Ste G
Tustin CA 92780-2939
Phone: (714) 665-9890
Fax: (714) 665-9891
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Gastroenterology | 207RG0100X | A41105 | California |
Profile Details
| NPI number | 1336134014 |
|---|---|
| LBN Legal business name | Menon, Moothedath A |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Sep 19th, 2005 |
| Last updated | Oct 22nd, 2025 - about last year |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1336134014 | NPPES |
| California | MEDICAID | 00A411050 |
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