Healthcare Provider Details

I. General information

NPI: 1689596140
Provider Name (Legal Business Name): HILLARY R MOORE RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2026
Last Update Date: 07/28/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1798 N GAREY AVE
POMONA CA
91767-2918
US

IV. Provider business mailing address

5130 E. HENLEY PL UNIT B
ORANGE CA
92867
US

V. Phone/Fax

Practice location:
  • Phone: 909-865-9500
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number769239
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: