Shannon Moore

NPI 1386095453 · on the registry since 2016

Practice

Address: 480 Alta Rd
San Diego, CA 92179
Phone: (619) 661-6500
Organisation at this address: Corrections And Rehabilitation-Headquarters
State Of California Prison Industry Authority
Inferred from a shared address, not stated in the registry.
Clinicians at this address: 143

Registry record

Primary taxonomy: 103TC0700X
103TC0700X
Licence states on file: CA
From the registry's licence fields, which are often incomplete.
Sex: Female
Record last updated: 2016-06-29

Source: CMS National Plan and Provider Enumeration System. Registration is not the same as practising, and the registry records no retirement — some people listed here no longer practise. More in California