MEDICARE: DR. LORI RIGGIO MOORHEAD PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103T00000X	Psychologist	PSY15963	CA

General Provider Information

NPI Number	:	1811331739
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LORI RIGGIO MOORHEAD PH.D.

Provider Business Mailing Address
First Line	:	5369 CAMDEN AVE STE 230
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95124-5809
Country	:	US
Telephone Number	:	408-220-3576
Fax Number	:

Provider Business Practice Location Address
First Line	:	5369 CAMDEN AVE STE 230
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95124-5809
Country	:	US
Telephone Number	:	408-220-3576
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/22/2013
Last Update Date	:	04/22/2013

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