MEDICARE: DR. SVETLANA MOORE M.D.

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	207Q00000X	Family Medicine Physician	A129688	CA

General Provider Information

NPI Number	:	1750678553
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SVETLANA MOORE M.D.

Provider Business Mailing Address
First Line	:	PO BOX 255228
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95865-5228
Country	:	US
Telephone Number	:
Fax Number	:	530-458-8660

Provider Business Practice Location Address
First Line	:	1590 POOLE BLVD
Second Line	:
City	:	YUBA CITY
State	:	CA
Zip	:	95993-2607
Country	:	US
Telephone Number	:	530-751-1800
Fax Number	:	530-751-3901

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

Provider Enumeration Date	:	06/30/2011
Last Update Date	:	11/11/2024

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