Healthcare Provider Details

I. General information

NPI: 1336639749
Provider Name (Legal Business Name): TIFFANI LASHAI MOORE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2018
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date: 07/15/2023
Reactivation Date: 08/23/2023

III. Provider practice location address

17801 INDUSTRIAL FARM RD
BAKERSFIELD CA
93308-9599
US

IV. Provider business mailing address

501 TAYLOR ST APT 55
BAKERSFIELD CA
93309-3024
US

V. Phone/Fax

Practice location:
  • Phone: 661-391-9130
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: