Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225400000X | Rehabilitation Practitioner |
NPI | 1023362928 |
---|---|
Provider Name | Mrs. Tamu H Moore |
First Address | Hawthorne, CA 90250-9025 |
Second Address | Los Angeles, CA 90031-2359 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/10/2012 |
Last Update Date | 31/10/2012 |