Provider Demographics
NPI:1033724729
Name:MOORE, CINTA LATRECE
Entity Type:Individual
Prefix:
First Name:CINTA
Middle Name:LATRECE
Last Name:MOORE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13308 MIDLAND RD UNIT 9
Mailing Address - Street 2:
Mailing Address - City:POWAY
Mailing Address - State:CA
Mailing Address - Zip Code:92074-7002
Mailing Address - Country:US
Mailing Address - Phone:951-837-9532
Mailing Address - Fax:
Practice Address - Street 1:12329 CREEKVIEW DR UNIT 37
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92128-6624
Practice Address - Country:US
Practice Address - Phone:661-378-2789
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-10
Last Update Date:2020-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAD7665830OtherDRIVER LICENSE