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General NPI Number Information
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NPI Number | 1033825591
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Entity Type | Individual
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Provider Name | MISS CAROLYN BRUNETTE MOORE
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Gender | Female
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Dates
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Enumeration Date | 01/27/2023
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Last Update Date | 07/07/2023
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Provider Practice Location Address
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Address Line | 7912 DUBLIN FRST
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City | SAN ANTONIO
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State | TX
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Zip | 78253-4444
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Country | US
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Telephone | 901-585-1593
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Fax |
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Provider Business Mailing Address
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Address Line | 7912 DUBLIN FRST
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City | SAN ANTONIO
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State | TX
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Zip | 78253-4444
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Country | US
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Telephone | 901-585-1593
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Fax | 707-652-1112
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171WH0202X
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Taxonomy Name | Home Modifications Contractor
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License Number | 804920727
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License Number State | TX
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