Healthcare Provider Details

I. General information

NPI: 1467557405
Provider Name (Legal Business Name): REBECCA MOORE RN., CDE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 SANTA FE DR
ENCINITAS CA
92024-5110
US

IV. Provider business mailing address

54433 FILE
LOS ANGELES CA
90074-0001
US

V. Phone/Fax

Practice location:
  • Phone: 760-753-5594
  • Fax: 858-784-5933
Mailing address:
  • Phone: 858-784-5767
  • Fax: 858-784-5933

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number247010
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: