Provider Demographics
NPI:1548390446
Name:MOORE, IAN H (ND)
Entity Type:Individual
Prefix:DR
First Name:IAN
Middle Name:H
Last Name:MOORE
Suffix:
Gender:M
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11930 RANCHO BERNARDO RD
Mailing Address - Street 2:#120
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92128-2074
Mailing Address - Country:US
Mailing Address - Phone:858-442-7100
Mailing Address - Fax:
Practice Address - Street 1:11930 RANCHO BERNARDO RD
Practice Address - Street 2:#120
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92128-2074
Practice Address - Country:US
Practice Address - Phone:858-442-7100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-07
Last Update Date:2009-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAND-35175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath