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NPI Code Detail

MEDICARE: MR. LANCE S. MOORE

MEDICARE: MR. LANCE S. 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
1225400000XRehabilitation Practitioner

General Provider Information

NPI Number : 1902016421
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. LANCE S. MOORE
Provider Business Mailing Address
First Line : 6400 GREEN VALLEY CIR APT 302
Second Line :
City : CULVER CITY
State : CA
Zip : 90230-7008
Country : US
Telephone Number : 310-394-6889
Fax Number : 310-394-6883
Provider Business Practice Location Address
First Line : 6400 GREEN VALLEY CIR APT 302
Second Line :
City : CULVER CITY
State : CA
Zip : 90230-7008
Country : US
Telephone Number : 310-394-6889
Fax Number : 310-394-6883
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/23/2007
Last Update Date : 06/07/2013

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