MEDICARE: MR. HUGH E. MOORE RN

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	163WP0809X	Adult Psychiatric/Mental Health Registered Nurse	701545	CA

General Provider Information

NPI Number	:	1285821462
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. HUGH E. MOORE RN

Provider Business Mailing Address
First Line	:	2961 EDELL PL
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92117-1618
Country	:	US
Telephone Number	:	619-793-5397
Fax Number	:

Provider Business Practice Location Address
First Line	:	2961 EDELL PL
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92117-1618
Country	:	US
Telephone Number	:	619-793-5397
Fax Number	:

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

Provider Enumeration Date	:	10/01/2007
Last Update Date	:	04/09/2014

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