MEDICARE: AMBER 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	103K00000X	Behavior Analyst	1-22-58694	CA

General Provider Information

NPI Number	:	1376046318
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMBER MOORE

Provider Business Mailing Address
First Line	:	1610 W 126TH ST
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90047-5226
Country	:	US
Telephone Number	:	424-227-2024
Fax Number	:

Provider Business Practice Location Address
First Line	:	708 S LONG STAR WAY
Second Line	:
City	:	ELGIN
State	:	SC
Zip	:	29045-8575
Country	:	US
Telephone Number	:	424-227-2024
Fax Number	:

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

Provider Enumeration Date	:	03/15/2018
Last Update Date	:	05/22/2026

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Directions to “ AMBER MOORE ” Practice Location

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