Provider Demographics
NPI:1639301088
Name:MOORE, VICTORIA J (PA-C)
Entity Type:Individual
Prefix:
First Name:VICTORIA
Middle Name:J
Last Name:MOORE
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Gender:F
Credentials:PA-C
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Mailing Address - Street 1:1671 E MONTE VISTA AVE
Mailing Address - Street 2:STE 213
Mailing Address - City:VACAVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95688-3124
Mailing Address - Country:US
Mailing Address - Phone:707-447-2407
Mailing Address - Fax:707-447-2271
Practice Address - Street 1:1671 E MONTE VISTA AVE
Practice Address - Street 2:STE 213
Practice Address - City:VACAVILLE
Practice Address - State:CA
Practice Address - Zip Code:95688-3124
Practice Address - Country:US
Practice Address - Phone:707-447-2407
Practice Address - Fax:707-447-2271
Is Sole Proprietor?:No
Enumeration Date:2009-08-19
Last Update Date:2010-04-05
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Provider Licenses
StateLicense IDTaxonomies
CA20217363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant