Provider Demographics
NPI:1952968349
Name:MOORE, ROBIN ALEXIS
Entity Type:Individual
Prefix:
First Name:ROBIN
Middle Name:ALEXIS
Last Name:MOORE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4180 AMITY LN
Mailing Address - Street 2:
Mailing Address - City:PILOT HILL
Mailing Address - State:CA
Mailing Address - Zip Code:95664-9636
Mailing Address - Country:US
Mailing Address - Phone:530-305-3584
Mailing Address - Fax:
Practice Address - Street 1:6030 W OAKS BLVD STE 170
Practice Address - Street 2:
Practice Address - City:ROCKLIN
Practice Address - State:CA
Practice Address - Zip Code:95765-4437
Practice Address - Country:US
Practice Address - Phone:916-824-3220
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-22
Last Update Date:2019-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
XEH901597446OtherBLUESHIELD