Individual provider · Type 1 NPI

Tina Lee Moon, PA-C

Physician Assistant · San Dimas, CA

NPI number 1104946383 Active

Practice location

1334 W Covina Blvd, Suite 102
San Dimas, CA 91773-3211

Call (909) 599-8677 Map

Fax (909) 592-0999

Mailing address

7809 Hemlock Ave
Hesperia, CA 92345-4119

Specialties and licenses

TaxonomyCodeLicense
Physician Assistant Primary 363A00000X15164 (CA)

Physician Assistant: A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, orde…

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About NPI 1104946383

Tina Lee Moon, PA-C's National Provider Identifier is 1104946383, issued on Mar 30, 2007. The primary taxonomy on file is Physician Assistant (363A00000X), and the practice location is in San Dimas, CA. The record was last updated on Jul 21, 2026.