Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN0400X | Neurology | 14907 | CA |
N | 111NS0005X | Chiropractic Sports Physician | 14907 | CA |
NPI | 1740340074 |
---|---|
Provider Name | Dr. Victoria Moore |
First Address | San Anselmo, CA 94960-1649 |
Second Address | San Rafael, CA 94901-3123 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/12/2006 |
Last Update Date | 14/04/2014 |