Provider Demographics
NPI:1447698600
Name:MOORE, PRISCILLA
Entity type:Individual
Prefix:MS
First Name:PRISCILLA
Middle Name:
Last Name:MOORE
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:PRISCILLA
Other - Middle Name:
Other - Last Name:CASTRO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:1499 HUNTINGTON DR STE 101
Mailing Address - Street 2:
Mailing Address - City:S PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91030-5444
Mailing Address - Country:US
Mailing Address - Phone:626-403-4370
Mailing Address - Fax:626-403-4260
Practice Address - Street 1:1499 HUNTINGTON DR STE 101
Practice Address - Street 2:
Practice Address - City:S PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91030-5444
Practice Address - Country:US
Practice Address - Phone:626-403-4370
Practice Address - Fax:626-403-4260
Is Sole Proprietor?:No
Enumeration Date:2013-06-10
Last Update Date:2013-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARN409596163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse