Provider Demographics
NPI:1902016421
Name:MOORE, LANCE S
Entity Type:Individual
Prefix:MR
First Name:LANCE
Middle Name:S
Last Name:MOORE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6400 GREEN VALLEY CIR APT 302
Mailing Address - Street 2:
Mailing Address - City:CULVER CITY
Mailing Address - State:CA
Mailing Address - Zip Code:90230-7008
Mailing Address - Country:US
Mailing Address - Phone:310-394-6889
Mailing Address - Fax:310-394-6883
Practice Address - Street 1:6400 GREEN VALLEY CIR APT 302
Practice Address - Street 2:
Practice Address - City:CULVER CITY
Practice Address - State:CA
Practice Address - Zip Code:90230-7008
Practice Address - Country:US
Practice Address - Phone:310-394-6889
Practice Address - Fax:310-394-6883
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2013-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner