Provider Demographics
NPI:1043364276
Name:MOORE, MARJORIE (LAC OMD)
Entity Type:Individual
Prefix:
First Name:MARJORIE
Middle Name:
Last Name:MOORE
Suffix:
Gender:F
Credentials:LAC OMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18022 HOLLY CIR
Mailing Address - Street 2:
Mailing Address - City:YORBA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92886-5220
Mailing Address - Country:US
Mailing Address - Phone:714-528-0216
Mailing Address - Fax:714-993-2594
Practice Address - Street 1:115 E 2ND ST 101
Practice Address - Street 2:ACUCARE HOLISTIC HEALTH CENTER
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92780
Practice Address - Country:US
Practice Address - Phone:714-528-0216
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC2625171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist