Provider Demographics
NPI:1871316430
Name:MOODY, AMBER (MS)
Entity type:Individual
Prefix:
First Name:AMBER
Middle Name:
Last Name:MOODY
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2390 CANTALISE DR
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:CA
Mailing Address - Zip Code:94568-7835
Mailing Address - Country:US
Mailing Address - Phone:415-420-7549
Mailing Address - Fax:
Practice Address - Street 1:2390 CANTALISE DR
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:CA
Practice Address - Zip Code:94568-7835
Practice Address - Country:US
Practice Address - Phone:415-420-7549
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-04
Last Update Date:2024-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach