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General NPI Number Information
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NPI Number | 1386216414
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Entity Type | Individual
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Provider Name | JOSHUA JACOB MOORE
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Gender | Male
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Dates
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Enumeration Date | 07/16/2021
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Last Update Date | 07/16/2021
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Provider Practice Location Address
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Address Line | 2141 PALOMAR AIRPORT RD STE 350
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City | CARLSBAD
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State | CA
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Zip | 92011-1451
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Country | US
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Telephone | 760-438-0078
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Fax |
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Provider Business Mailing Address
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Address Line | 1641 TUCKER LN
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City | ENCINITAS
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State | CA
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Zip | 92024-2925
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Country | US
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Telephone | 858-449-0619
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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 | 247200000X
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Taxonomy Name | Other Technician
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License Number |
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License Number State |
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