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General NPI Number Information
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NPI Number | 1063253615
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Entity Type | Individual
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Provider Name | SAHARI ISABEL MOORE
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Gender | Female
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Dates
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Enumeration Date | 06/05/2024
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Last Update Date | 06/05/2024
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Provider Practice Location Address
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Address Line | 506 W GRAHAM AVE SUITE 106
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City | LAKE ILSINORE
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State | CA
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Zip | 92530
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Country | US
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Telephone | 888-638-8457
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Fax |
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Provider Business Mailing Address
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Address Line | 8118 1/4 CHESTNUT AVE
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City | SOUTH GATE
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State | CA
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Zip | 90280
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Country | US
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Telephone | 213-544-7250
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Fax |
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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 | 175T00000X
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Taxonomy Name | Peer Specialist
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License Number | MPSS-LUOECV
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 172V00000X
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Taxonomy Name | Community Health Worker
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License Number |
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License Number State | CA
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