Provider Demographics
NPI:1972510196
Name:MOORE, LORI DARLENE (MD)
Entity Type:Individual
Prefix:DR
First Name:LORI
Middle Name:DARLENE
Last Name:MOORE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:7 W FOOTHILL BLVD
Mailing Address - Street 2:SUITE 3
Mailing Address - City:ARCADIA
Mailing Address - State:CA
Mailing Address - Zip Code:91006-2367
Mailing Address - Country:US
Mailing Address - Phone:626-357-2020
Mailing Address - Fax:626-357-9020
Practice Address - Street 1:7 W FOOTHILL BLVD
Practice Address - Street 2:SUITE 3
Practice Address - City:ARCADIA
Practice Address - State:CA
Practice Address - Zip Code:91006-2367
Practice Address - Country:US
Practice Address - Phone:626-357-2020
Practice Address - Fax:626-357-9020
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2016-03-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG57630207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G576300Medicaid
CAG57630Medicare ID - Type Unspecified
CA00G576300Medicaid