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General NPI Number Information
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NPI Number | 1912351396
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Entity Type | Individual
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Provider Name | BRYAN MOORE LVN
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Gender | Male
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Dates
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Enumeration Date | 04/21/2016
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Last Update Date | 12/02/2025
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Provider Practice Location Address
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Address Line | 245 VICTORIA ST SUITE 1H
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City | COSTA MESA
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State | CA
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Zip | 92627
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Country | US
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Telephone | 949-629-2860
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Fax | 949-629-2867
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Provider Business Mailing Address
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Address Line | 20423 VIA DON JUAN
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City | YORBA LINDA
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State | CA
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Zip | 92886-3047
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Country | US
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Telephone | 714-650-6061
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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 | 164X00000X
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Taxonomy Name | Licensed Vocational Nurse
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License Number | 735990
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License Number State | CA
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