Provider Demographics
NPI:1568611358
Name:MOORE, AMANDA JO (DO)
Entity Type:Individual
Prefix:DR
First Name:AMANDA
Middle Name:JO
Last Name:MOORE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:JO
Other - Last Name:POST
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:9808 VENICE BLVD
Mailing Address - Street 2:EXODUS RECOVERY
Mailing Address - City:CULVER CITY
Mailing Address - State:CA
Mailing Address - Zip Code:90232
Mailing Address - Country:US
Mailing Address - Phone:310-945-3350
Mailing Address - Fax:858-822-0231
Practice Address - Street 1:1920 MARENGO ST
Practice Address - Street 2:EXODUS RECOVERY
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90033
Practice Address - Country:US
Practice Address - Phone:323-276-6400
Practice Address - Fax:858-822-0231
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-16
Last Update Date:2021-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA110452084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry