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NPI Code Detail

MEDICARE: BRENTON L MOORE

MEDICARE: BRENTON L MOORE
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225400000XRehabilitation Practitioner

General Provider Information

NPI Number : 1073633111
Entity Type Code : Individual
Provider Name (Legal Business Name) : BRENTON L MOORE
Provider Business Mailing Address
First Line : 254 E WASHINGTON BLVD
Second Line : 109
City : PASADENA
State : CA
Zip : 91104-2160
Country : US
Telephone Number : 626-345-0659
Fax Number :
Provider Business Practice Location Address
First Line : 2055 LINCOLN AVE
Second Line :
City : PASADENA
State : CA
Zip : 91103-1324
Country : US
Telephone Number : 626-255-2853
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/30/2007
Last Update Date : 07/08/2007

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Directions to “ BRENTON L MOORE ” Practice Location

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