Healthcare Provider Details

I. General information

NPI: 1013701499
Provider Name (Legal Business Name): ALYSSA MOORE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/08/2025
Last Update Date: 04/08/2025
Certification Date: 04/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3037 BRYANT PL
DAVIS CA
95618-1613
US

IV. Provider business mailing address

10801 OAKTON WAY
RANCHO CORDOVA CA
95670-2440
US

V. Phone/Fax

Practice location:
  • Phone: 916-532-4851
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number95228706
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: