1588857981 NPI number — MRS. WENDY HEATHER MOORE O.T.

Table of content: MRS. WENDY HEATHER MOORE O.T. (NPI 1588857981)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1588857981 NPI number — MRS. WENDY HEATHER MOORE O.T.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MOORE
Provider First Name:
WENDY
Provider Middle Name:
HEATHER
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
O.T.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
STEINER
Provider Other First Name:
WENDY
Provider Other Middle Name:
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
O.T.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1588857981
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/15/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
540 S ANDREASEN DR
Provider Second Line Business Mailing Address:
STE C
Provider Business Mailing Address City Name:
ESCONDIDO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92029-1916
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
760-591-7750
Provider Business Mailing Address Fax Number:
760-294-9813

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9909 MIRA MESA BLVD
Provider Second Line Business Practice Location Address:
STE 120
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92131-1056
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-693-0436
Provider Business Practice Location Address Fax Number:
858-693-0437
Provider Enumeration Date:
08/20/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225XH1200X , with the licence number:  OT 6668 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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