MEDICARE: MONIQUE 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
1	347C00000X	Private Vehicle	RH506449	OH
2	347C00000X	Private Vehicle

General Provider Information

NPI Number	:	1194612002
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MONIQUE MOORE

Provider Business Mailing Address
First Line	:	12904 LENACRAVE AVE
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44105-4461
Country	:	US
Telephone Number	:	216-780-4824
Fax Number	:

Provider Business Practice Location Address
First Line	:	12904 LENACRAVE AVE
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44105-4461
Country	:	US
Telephone Number	:	216-780-4824
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/23/2025
Last Update Date	:	06/25/2025

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Directions to “ MONIQUE MOORE ” Practice Location

Language	Start Address	Practice Location

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