Provider Demographics
NPI:1558538058
Name:MOORE, OMAR-KAREEM TOUSSAINT
Entity Type:Individual
Prefix:MR
First Name:OMAR-KAREEM
Middle Name:TOUSSAINT
Last Name:MOORE
Suffix:
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:OMAR-KAREEM
Other - Middle Name:TOUSSAINT
Other - Last Name:MOORE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:3500 W MANCHESTER BLVD
Mailing Address - Street 2:393
Mailing Address - City:INGLEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90305-2164
Mailing Address - Country:US
Mailing Address - Phone:323-828-3217
Mailing Address - Fax:
Practice Address - Street 1:130 W VICTORIA ST
Practice Address - Street 2:
Practice Address - City:GARDENA
Practice Address - State:CA
Practice Address - Zip Code:90248-3523
Practice Address - Country:US
Practice Address - Phone:310-715-2020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-14
Last Update Date:2008-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor