Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223E0200X | Endodontist | 35765 | CA |
NPI | 1124117825 |
---|---|
Provider Name | Victoria E. Moore |
First Address | San Mateo, CA 94401-2621 |
Second Address | San Mateo, CA 94401-2621 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/10/2006 |
Last Update Date | 08/07/2007 |