MEDICARE: LA SHRERON ROCHAL 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	1041C0700X	Clinical Social Worker	11610-C	NV

General Provider Information

NPI Number	:	1225685662
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LA SHRERON ROCHAL MOORE

Provider Business Mailing Address
First Line	:	9277 VERVAIN CT
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89149-1647
Country	:	US
Telephone Number	:	909-272-3684
Fax Number	:

Provider Business Practice Location Address
First Line	:	9277 VERVAIN CT
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89149-1647
Country	:	US
Telephone Number	:	909-272-3684
Fax Number	:

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

Provider Enumeration Date	:	08/21/2019
Last Update Date	:	03/11/2025

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