Provider Demographics
NPI:1043525967
Name:JOANN BLESSING - MOORE MD INC
Entity type:Organization
Organization Name:JOANN BLESSING - MOORE MD INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOANN
Authorized Official - Middle Name:C
Authorized Official - Last Name:BLESSING-MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:650-906-4998
Mailing Address - Street 1:5 QUAIL MEADOW DR
Mailing Address - Street 2:
Mailing Address - City:WOODSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:94062-2499
Mailing Address - Country:US
Mailing Address - Phone:650-688-8480
Mailing Address - Fax:650-688-8483
Practice Address - Street 1:723 EMERSON ST
Practice Address - Street 2:STE 204
Practice Address - City:PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94301-2411
Practice Address - Country:US
Practice Address - Phone:650-688-8480
Practice Address - Fax:650-688-8483
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-16
Last Update Date:2015-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG-26617207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G266170Medicare PIN
C04156Medicare UPIN