Provider Demographics
NPI:1780842799
Name:MOORE, VICTOR STEPHEN (PA-C)
Entity Type:Individual
Prefix:MR
First Name:VICTOR
Middle Name:STEPHEN
Last Name:MOORE
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Gender:M
Credentials:PA-C
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Mailing Address - Street 1:4791 E PALM CANYON DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:PALM SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:92264-5220
Mailing Address - Country:US
Mailing Address - Phone:760-834-7950
Mailing Address - Fax:760-834-7951
Practice Address - Street 1:4791 E PALM CANYON DR
Practice Address - Street 2:SUITE 200
Practice Address - City:PALM SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:92264-5220
Practice Address - Country:US
Practice Address - Phone:760-834-7950
Practice Address - Fax:760-834-7951
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-27
Last Update Date:2012-06-18
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Provider Licenses
StateLicense IDTaxonomies
CA19745363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical