Healthcare Provider Details

I. General information

NPI: 1295648699
Provider Name (Legal Business Name): JUSTIN MOORE RN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/25/2026
Last Update Date: 09/25/2026
Certification Date: 09/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1531 ESPLANADE
CHICO CA
95926-3310
US

IV. Provider business mailing address

713 BRUSH CREEK LN
CHICO CA
95973-7736
US

V. Phone/Fax

Practice location:
  • Phone: 925-381-1435
  • Fax:
Mailing address:
  • Phone: 925-381-1435
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License Number95088328
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: