MEDICARE: ANGELA MOORE-HODGE

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	207RG0300X	Geriatric Medicine (Internal Medicine) Physician	PA11502	CA

General Provider Information

NPI Number	:	1295932937
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANGELA MOORE-HODGE

Provider Business Mailing Address
First Line	:	2975 WILSHIRE BLVD STE 401
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90010-1112
Country	:	US
Telephone Number	:	213-368-1654
Fax Number	:	213-368-1658

Provider Business Practice Location Address
First Line	:	2975 WILSHIRE BLVD STE 401
Second Line	:	4116 CAMINO REAL LOS ANGELES, CA. 90065
City	:	LOS ANGELES
State	:	CA
Zip	:	90010-1112
Country	:	US
Telephone Number	:	213-368-1654
Fax Number	:	213-368-1658

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

Provider Enumeration Date	:	06/27/2007
Last Update Date	:	07/31/2007

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Directions to “ ANGELA MOORE-HODGE ” Practice Location

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