Healthcare Provider Details

I. General information

NPI: 1194642629
Provider Name (Legal Business Name): VERLANCIA NICOLE MOORE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2026
Last Update Date: 07/06/2026
Certification Date: 07/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

309 E MOUNTAIN VIEW ST STE 108
BARSTOW CA
92311-2814
US

IV. Provider business mailing address

2011 BORREGO DR APT 39
BARSTOW CA
92311-6754
US

V. Phone/Fax

Practice location:
  • Phone: 442-321-9172
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: