MEDICARE: PRENISHA MOORE ANGELIC 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	335E00000X	Prosthetic/Orthotic Supplier		CA
2	332B00000X	Durable Medical Equipment & Medical Supplies		CA

General Provider Information

NPI Number	:	1942193180
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PRENISHA MOORE ANGELIC MOORE

Provider Business Mailing Address
First Line	:	5222 PENDLETON AVE APT 14
Second Line	:
City	:	SOUTH GATE
State	:	CA
Zip	:	90280-8537
Country	:	US
Telephone Number	:	323-861-4158
Fax Number	:

Provider Business Practice Location Address
First Line	:	5222 PENDLETON AVE APT 14
Second Line	:
City	:	SOUTH GATE
State	:	CA
Zip	:	90280-8537
Country	:	US
Telephone Number	:	323-861-4158
Fax Number	:

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

Provider Enumeration Date	:	05/29/2025
Last Update Date	:	05/29/2025

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Directions to “ PRENISHA MOORE ANGELIC MOORE ” Practice Location

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