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General NPI Number Information
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NPI Number | 1558187351
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Entity Type | Individual
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Provider Name | MS. RYEISHA SHAWNTAE MOORE-NASH
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Gender | Female
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Dates
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Enumeration Date | 11/26/2024
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Last Update Date | 11/26/2024
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Provider Practice Location Address
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Address Line | 320 N MADISON AVE STE B
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City | LOS ANGELES
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State | CA
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Zip | 90004-3791
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Country | US
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Telephone | 661-794-8989
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Fax |
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Provider Business Mailing Address
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Address Line | 21032 79TH ST
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City | CALIFORNIA CITY
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State | CA
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Zip | 93505-1809
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Country | US
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Telephone | 661-794-8989
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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 | 225400000X
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Taxonomy Name | Rehabilitation Practitioner
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License Number |
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License Number State |
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