=====================================================
General NPI Number Information
=====================================================
NPI Number | 1316891476
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ADELAIDA B MOORE MPSS
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/25/2026
-----------------------------------------------------
Last Update Date | 02/25/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 113 E NORTH ST
-----------------------------------------------------
City | ALTURAS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 96101-4054
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 530-233-9696
-----------------------------------------------------
Fax | 530-233-7222
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 653 COUNTY ROAD 261
-----------------------------------------------------
City | ALTURAS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 96101-7533
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 530-233-9696
-----------------------------------------------------
Fax | 530-233-7222
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 175T00000X
-----------------------------------------------------
Taxonomy Name | Peer Specialist
-----------------------------------------------------
License Number | MPSS-BOVNDM
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------