Healthcare Provider Details

I. General information

NPI: 1053464743
Provider Name (Legal Business Name): MS. SARAH GRACE MOORE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/18/2007
Last Update Date: 05/13/2025
Certification Date: 05/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 S GRAND AVE
SANTA ANA CA
92705-4434
US

IV. Provider business mailing address

215 14TH ST APT B
SEAL BEACH CA
90740-7224
US

V. Phone/Fax

Practice location:
  • Phone: 714-567-7647
  • Fax:
Mailing address:
  • Phone: 916-899-0339
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: