Basic Information
| Provider Information | |||||||||
| NPI: | 1366861767 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MOORE | ||||||||
| FirstName: | ANDREW | ||||||||
| MiddleName: | CHRISTOPHER | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4136 OREGON ST | ||||||||
| Address2: | |||||||||
| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 921041726 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3017676247 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | NBHC NAVAL BASE CORONADO | ||||||||
| Address2: | BLDG. 601 | ||||||||
| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 921357046 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6195454359 | ||||||||
| FaxNumber: | 6195450452 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/14/2014 | ||||||||
| LastUpdateDate: | 10/24/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/18/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 171000000X | 0101258752 | VA | Y | Other Service Providers | Military Health Care Provider |
No ID Information.