Healthcare Provider Details

I. General information

NPI: 1407789167
Provider Name (Legal Business Name): LAUREN MOORE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/03/2026
Last Update Date: 06/03/2026
Certification Date: 06/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6121 INDIAN SCHOOL RD NE STE 101
ALBUQUERQUE NM
87110-4165
US

IV. Provider business mailing address

5304 EDWARDS DR NE
ALBUQUERQUE NM
87111-1960
US

V. Phone/Fax

Practice location:
  • Phone: 505-624-8661
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: