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NPI Code Detail

MEDICARE: MILLICENT GABRIELLE MOORE

MEDICARE: MILLICENT GABRIELLE 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
13747A0650XAttendant Care Provider

General Provider Information

NPI Number : 1952910705
Entity Type Code : Individual
Provider Name (Legal Business Name) : MILLICENT GABRIELLE MOORE
Provider Business Mailing Address
First Line : 3170 BANCROFT DR APT 1
Second Line :
City : SPRING VALLEY
State : CA
Zip : 91977-2669
Country : US
Telephone Number : 224-469-5290
Fax Number :
Provider Business Practice Location Address
First Line : 1001 S HALE AVE SPC 54
Second Line :
City : ESCONDIDO
State : CA
Zip : 92029-2177
Country : US
Telephone Number : 760-729-8295
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/28/2020
Last Update Date : 07/28/2020

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1881226454 — CHRISTINA HELEN RAMIREZ-CORZA
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1356958151 — AMELIA DIAZ
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Directions to “ MILLICENT GABRIELLE MOORE ” Practice Location

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