Provider Demographics
NPI:1225685662
Name:MOORE, LA SHRERON ROCHAL
Entity Type:Individual
Prefix:
First Name:LA SHRERON
Middle Name:ROCHAL
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 1:9277 VERVAIN CT
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89149-1647
Mailing Address - Country:US
Mailing Address - Phone:909-272-3684
Mailing Address - Fax:
Practice Address - Street 1:9277 VERVAIN CT
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89149-1647
Practice Address - Country:US
Practice Address - Phone:909-272-3684
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-21
Last Update Date:2022-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst