Provider Demographics
NPI:1578642278
Name:MOORE, JANINE ANNETTE (MARRIAGE AND FAMILY)
Entity Type:Individual
Prefix:MRS
First Name:JANINE
Middle Name:ANNETTE
Last Name:MOORE
Suffix:
Gender:F
Credentials:MARRIAGE AND FAMILY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 70433
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92513-0433
Mailing Address - Country:US
Mailing Address - Phone:951-358-4390
Mailing Address - Fax:951-358-4472
Practice Address - Street 1:10000 COUNTY FARM ROAD
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92503
Practice Address - Country:US
Practice Address - Phone:951-358-4390
Practice Address - Fax:951-358-4472
Is Sole Proprietor?:No
Enumeration Date:2006-11-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC31899106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist