Healthcare Provider Details

I. General information

NPI: 1669626008
Provider Name (Legal Business Name): MARIA CRISTINA MOORE RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MA CRISTINA MOORE RN

II. Dates (important events)

Enumeration Date: 11/12/2008
Last Update Date: 11/12/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 N FLOWER ST
SANTA ANA CA
92703-2361
US

IV. Provider business mailing address

550 N FLOWER ST
SANTA ANA CA
92703-2361
US

V. Phone/Fax

Practice location:
  • Phone: 714-647-4172
  • Fax: 714-647-1865
Mailing address:
  • Phone: 714-647-4172
  • Fax: 714-647-1865

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number632564
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number632564
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: