Healthcare Provider Details

I. General information

NPI: 1265026819
Provider Name (Legal Business Name): ZE'CHARIAH HEPHZIBAH-MOORE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/24/2021
Last Update Date: 02/24/2021
Certification Date: 02/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14329 OAKRIDGE CIR APT 701
FORT WORTH TX
76155-3885
US

IV. Provider business mailing address

14329 OAKRIDGE CIR APT 701
FORT WORTH TX
76155-3885
US

V. Phone/Fax

Practice location:
  • Phone: 972-804-2470
  • Fax:
Mailing address:
  • Phone: 972-804-2470
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: