Healthcare Provider Details

I. General information

NPI: 1639059900
Provider Name (Legal Business Name): MARVELLA MOORE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/05/2025
Last Update Date: 09/05/2025
Certification Date: 09/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

699 S C ST
OXNARD CA
93030-7016
US

IV. Provider business mailing address

629 W IMPERIAL HWY
LOS ANGELES CA
90044-4224
US

V. Phone/Fax

Practice location:
  • Phone: 805-312-0777
  • Fax:
Mailing address:
  • Phone: 805-312-0777
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number157222
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: