Healthcare Provider Details

I. General information

NPI: 1194637025
Provider Name (Legal Business Name): CARI MOORE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/17/2026
Last Update Date: 09/17/2026
Certification Date: 09/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31 RANCHO CAMINO DR
POMONA CA
91766-7030
US

IV. Provider business mailing address

511 OAK ST APT 4
EL CERRITO CA
94530-3643
US

V. Phone/Fax

Practice location:
  • Phone: 443-430-7570
  • Fax:
Mailing address:
  • Phone: 510-942-9607
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: