Healthcare Provider Details

I. General information

NPI: 1679410534
Provider Name (Legal Business Name): DARYL MOORE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/30/2026
Last Update Date: 04/30/2026
Certification Date: 04/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7521 S 13TH PL
PHOENIX AZ
85042-5664
US

IV. Provider business mailing address

7521 S 13TH PL
PHOENIX AZ
85042-5664
US

V. Phone/Fax

Practice location:
  • Phone: 480-942-8686
  • Fax:
Mailing address:
  • Phone: 480-942-8686
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code342000000X
TaxonomyTransportation Network Company
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: