MEDICARE: JACOB RYAN 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	164X00000X	Licensed Vocational Nurse	722770	CA

General Provider Information

NPI Number	:	1346008844
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JACOB RYAN MOORE

Provider Business Mailing Address
First Line	:	2609 K ST APT 11
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95816-5112
Country	:	US
Telephone Number	:	916-230-5613
Fax Number	:

Provider Business Practice Location Address
First Line	:	10821 FAIR OAKS BLVD
Second Line	:
City	:	FAIR OAKS
State	:	CA
Zip	:	95628-7214
Country	:	US
Telephone Number	:	916-903-7028
Fax Number	:

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

Provider Enumeration Date	:	03/08/2024
Last Update Date	:	03/08/2024

Similar Medicare Providers

1386205680 — AKUA BEHAVIORAL HEALTH, INC
Practice Location Address:

10821 FAIR OAKS BLVD
FAIR OAKS, CA
95628-7214

Practice Phone: 949-777-2283
Practice Fax:

1376105205 — AKUA BEHAVIORAL HEALTH, INC
Practice Location Address:

10827 FAIR OAKS BLVD
FAIR OAKS, CA
95628-7214

Practice Phone: 949-777-2283
Practice Fax:

1215500640 — MARK MELTEN
Practice Location Address:

10821 FAIR OAKS BLVD
FAIR OAKS, CA
95628-7214

Practice Phone: 916-516-1560
Practice Fax:

1023252434 — SONIA EUNCIE DE SILVA MS CCC-SLP
Practice Location Address:

16320 MELLOW OAKS LN
SUGAR LAND, TX
77498-7214

Practice Phone: 281-710-7035
Practice Fax:

1063993665 — LILIAN VINCENT NURSE RN
Practice Location Address:

16320 MELLOW OAKS LN
SUGAR LAND, TX
77498-7214

Practice Phone: 281-460-2256
Practice Fax:

1639650856 — ADETOUN OMOLOLA ARIYIBI RN
Practice Location Address:

16320 MELLOW OAKS LN
SUGAR LAND, TX
77498-7214

Practice Phone: 713-702-6240
Practice Fax:

Directions to “ JACOB RYAN MOORE ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.