Basic Information
| Provider Information | |||||||||
| NPI: | 1467557405 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MOORE | ||||||||
| FirstName: | REBECCA | ||||||||
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| Credential: | RN., CDE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 54433 FILE | ||||||||
| Address2: | |||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900740001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8587845767 | ||||||||
| FaxNumber: | 8587845933 | ||||||||
| Practice Location | |||||||||
| Address1: | 310 SANTA FE DR | ||||||||
| Address2: | |||||||||
| City: | ENCINITAS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 920245110 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7607535594 | ||||||||
| FaxNumber: | 8587845933 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/14/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 133NN1002X | 247010 | CA | Y | Dietary & Nutritional Service Providers | Nutritionist | Nutrition, Education |
No ID Information.