Provider Demographics
NPI:1407484546
Name:MOORE, ALEXANDRA C
Entity Type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:C
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 1:1805 W BOOKER AVE
Mailing Address - Street 2:
Mailing Address - City:ARTESIA
Mailing Address - State:NM
Mailing Address - Zip Code:88210-2585
Mailing Address - Country:US
Mailing Address - Phone:575-449-0458
Mailing Address - Fax:
Practice Address - Street 1:1805 W BOOKER AVE
Practice Address - Street 2:
Practice Address - City:ARTESIA
Practice Address - State:NM
Practice Address - Zip Code:88210-2585
Practice Address - Country:US
Practice Address - Phone:575-449-0458
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-01
Last Update Date:2020-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician