Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | G64016 | CA |
Y | 208600000X | Surgeon | G64016 | CA |
N | 2086S0120X | Pediatric Surgery | G64016 | CA |
NPI | 1497783070 |
---|---|
Provider Name | Donald Moores |
First Address | Los Angeles, CA 90074-4701 |
Second Address | Loma Linda, CA 92354-3450 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/06/2006 |
Last Update Date | 30/03/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00G640160 | (05) | CA |
F03188 | (02) |