Provider Demographics
NPI:1225491863
Name:MOODY, ALISON MARIE (MD/MPH)
Entity Type:Individual
Prefix:
First Name:ALISON
Middle Name:MARIE
Last Name:MOODY
Suffix:
Gender:F
Credentials:MD/MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4140 W 190TH ST
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90504-5513
Mailing Address - Country:US
Mailing Address - Phone:310-967-1780
Mailing Address - Fax:866-991-4287
Practice Address - Street 1:310 N SAN VICENTE BLVD FL 3
Practice Address - Street 2:
Practice Address - City:WEST HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:90048-1810
Practice Address - Country:US
Practice Address - Phone:310-423-9970
Practice Address - Fax:310-423-9587
Is Sole Proprietor?:No
Enumeration Date:2016-03-31
Last Update Date:2021-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CAA172211208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program