Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225C00000X | Rehabilitation Counselor | PSB94025865 | CA |
NPI | 1053989988 |
---|---|
Provider Name | Madison Moore |
First Address | Palmdale, CA 93550-2029 |
Second Address | Palmdale, CA 93550-2029 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/06/2021 |
Last Update Date | 02/08/2021 |