Provider Demographics
NPI:1750677886
Name:MOORE, TERESA L (LVN)
Entity Type:Individual
Prefix:MS
First Name:TERESA
Middle Name:L
Last Name:MOORE
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:730 BREEZE HILL RD
Mailing Address - Street 2:#284
Mailing Address - City:VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:92081-4319
Mailing Address - Country:US
Mailing Address - Phone:760-295-2286
Mailing Address - Fax:760-295-5904
Practice Address - Street 1:730 BREEZE HILL RD
Practice Address - Street 2:#284
Practice Address - City:VISTA
Practice Address - State:CA
Practice Address - Zip Code:92081-4319
Practice Address - Country:US
Practice Address - Phone:760-295-2286
Practice Address - Fax:760-295-5904
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-28
Last Update Date:2011-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN161112164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse