MEDICARE: MELODI M MOODY NURSE PRACTITIONER

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	163W00000X	Registered Nurse	RN 574386	CA
2	363LF0000X	Family Nurse Practitioner	16942	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1225179062
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MELODI M MOODY NURSE PRACTITIONER

Provider Business Mailing Address
First Line	:	PO BOX 5280
Second Line	:
City	:	HUNTINGTON BEACH
State	:	CA
Zip	:	92615-5280
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1141 W REDONDO BEACH BLVD STE 402
Second Line	:
City	:	GARDENA
State	:	CA
Zip	:	90247-3582
Country	:	US
Telephone Number	:	310-329-9492
Fax Number	:

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

Provider Enumeration Date	:	02/12/2007
Last Update Date	:	01/18/2023

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Directions to “ MELODI M MOODY NURSE PRACTITIONER” Practice Location

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