Healthcare Provider Details

I. General information

NPI: 1548211394
Provider Name (Legal Business Name): CHRIS ALAN MOORE RD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2006
Last Update Date: 07/13/2026
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2611 LOS MISIONEROS
LAS CRUCES NM
88011-9018
US

IV. Provider business mailing address

2611 LOS MISIONEROS
LAS CRUCES NM
88011-9018
US

V. Phone/Fax

Practice location:
  • Phone: 505-521-5901
  • Fax: 509-355-8154
Mailing address:
  • Phone: 505-521-5901
  • Fax: 509-355-8154

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number805015
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: