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General NPI Number Information
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NPI Number | 1831242221
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Entity Type | Organization
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Legal Business Name | MARCELLUS H. MOORE, M.D., INC.
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Dates
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Enumeration Date | 01/19/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 81225 KINGSTON HEATH
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City | LA QUINTA
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State | CA
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Zip | 92253-8741
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Country | US
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Telephone | 213-427-1148
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Fax | 213-427-1149
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Provider Business Mailing Address
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Address Line | 81225 KINGSTON HEATH
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City | LA QUINTA
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State | CA
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Zip | 92253-8741
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Country | US
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Telephone | 213-427-1148
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Fax | 213-427-1149
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Authorized Official
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Title or Position | PRESIDENT
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Name | MARCELLUS H. MOORE
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Credential | M.D.
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Telephone | 213-427-1148
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | C51387
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License Number State | CA
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