Provider Demographics
NPI:1891887238
Name:MOORE, CATHERINE DIANNE (MD)
Entity Type:Individual
Prefix:
First Name:CATHERINE
Middle Name:DIANNE
Last Name:MOORE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:591 CAMINO DE LA REINA
Mailing Address - Street 2:SUITE #820
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92108
Mailing Address - Country:US
Mailing Address - Phone:619-286-1010
Mailing Address - Fax:619-298-9129
Practice Address - Street 1:591 CAMINO DE LA REINA
Practice Address - Street 2:SUITE #820
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108
Practice Address - Country:US
Practice Address - Phone:619-286-1010
Practice Address - Fax:619-298-9129
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-29
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC409472084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAC40947OtherLICENSE
CA00C409470Medicaid
CAAM2146391OtherDEA
CA00C409470Medicaid