Provider Demographics
NPI:1093186801
Name:MOORE, JOSH SR (OWNER)
Entity Type:Individual
Prefix:MR
First Name:JOSH
Middle Name:
Last Name:MOORE
Suffix:SR
Gender:M
Credentials:OWNER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8735 INDEPENDENCE AVE
Mailing Address - Street 2:73
Mailing Address - City:CANOGA PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91304-6217
Mailing Address - Country:US
Mailing Address - Phone:310-867-1232
Mailing Address - Fax:
Practice Address - Street 1:8735 INDEPENDENCE AVE
Practice Address - Street 2:73
Practice Address - City:CANOGA PARK
Practice Address - State:CA
Practice Address - Zip Code:91304-6217
Practice Address - Country:US
Practice Address - Phone:310-867-1232
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-19
Last Update Date:2015-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health