MEDICARE: SAMANTHA RAE 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	235Z00000X	Speech-Language Pathologist		CA

General Provider Information

NPI Number	:	1730035502
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SAMANTHA RAE MOORE

Provider Business Mailing Address
First Line	:	38896 RED POST CIR
Second Line	:
City	:	MURRIETA
State	:	CA
Zip	:	92563-6206
Country	:	US
Telephone Number	:	951-219-4557
Fax Number	:

Provider Business Practice Location Address
First Line	:	690 OTAY LAKES RD STE 110
Second Line	:
City	:	CHULA VISTA
State	:	CA
Zip	:	91910-8904
Country	:	US
Telephone Number	:	619-475-6910
Fax Number	:

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

Provider Enumeration Date	:	03/05/2026
Last Update Date	:	03/05/2026

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Directions to “ SAMANTHA RAE MOORE ” Practice Location

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