Healthcare Provider Details

I. General information

NPI: 1700704582
Provider Name (Legal Business Name): ANDREA MICHELLE MOORE RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2026
Last Update Date: 07/08/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4600 BOHANNON DR STE 100
MENLO PARK CA
94025-1037
US

IV. Provider business mailing address

1172 DUNSMUIR PL
LIVERMORE CA
94550-6432
US

V. Phone/Fax

Practice location:
  • Phone: 650-507-7050
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number95181146
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: