Provider Demographics
NPI:1942937172
Name:MOORE, MORGAN (SPECIALIST)
Entity Type:Individual
Prefix:
First Name:MORGAN
Middle Name:
Last Name:MOORE
Suffix:
Gender:F
Credentials:SPECIALIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 GEORGIA ST STE 375
Mailing Address - Street 2:
Mailing Address - City:VALLEJO
Mailing Address - State:CA
Mailing Address - Zip Code:94590-5985
Mailing Address - Country:US
Mailing Address - Phone:707-563-5606
Mailing Address - Fax:
Practice Address - Street 1:301 GEORGIA ST STE 375
Practice Address - Street 2:
Practice Address - City:VALLEJO
Practice Address - State:CA
Practice Address - Zip Code:94590-5985
Practice Address - Country:US
Practice Address - Phone:707-563-5606
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-08
Last Update Date:2022-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAKK5704941744P3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case Management