Doctor Name: | FRED MCMOORE |
NPI Number: | 1679991855 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | |
License Number: | 36518 |
Business Practice Address: | 13781 Chagall Ct Moreno Valley, CA - 925536607 |
Business Phone Number: | 9512555347 |
Business Fax Number: | |
Mailing Address: | 1161 Hidden Valley Pkwy Ste 114, NORCO |
State: | CA |
Postal Code: | 928603917 |
Phone Number: | 9518170230 |
Fax Number: | |
NPI Enumeration Date: | 04/03/2014 |
NPI Last Update Date: | 04/03/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 174400000X |
License Number: | 36518 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | CA |
Taxonomy Type: | Other Service Providers |
Taxonomy Classification: | Specialist |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |