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General NPI Number Information
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NPI Number | 1952910705
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Entity Type | Individual
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Provider Name | MILLICENT GABRIELLE MOORE
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Gender | Female
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Dates
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Enumeration Date | 07/28/2020
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Last Update Date | 07/28/2020
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Provider Practice Location Address
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Address Line | 1001 S HALE AVE SPC 54
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City | ESCONDIDO
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State | CA
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Zip | 92029-2177
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Country | US
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Telephone | 760-729-8295
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Fax |
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Provider Business Mailing Address
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Address Line | 3170 BANCROFT DR APT 1
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City | SPRING VALLEY
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State | CA
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Zip | 91977-2669
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Country | US
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Telephone | 224-469-5290
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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 | 3747A0650X
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Taxonomy Name | Attendant Care Provider
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License Number |
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License Number State |
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