Healthcare Provider Details

I. General information

NPI: 1871014530
Provider Name (Legal Business Name): DOROTHY JAMES MOORE PMHNP - BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/03/2017
Last Update Date: 03/18/2025
Certification Date: 03/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2970 CAMINO DIABLO STE 300
WALNUT CREEK CA
94597-4001
US

IV. Provider business mailing address

2970 CAMINO DIABLO STE 300
WALNUT CREEK CA
94597-4001
US

V. Phone/Fax

Practice location:
  • Phone: 925-231-4225
  • Fax: 916-596-2135
Mailing address:
  • Phone: 925-231-4325
  • Fax: 916-596-2135

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number95006821
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: