# LISA C MOORE MD INC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1386696888
- **Authorized official:** DR. LISA C MOORE MD (PHYSICIAN & PRESIDENT)
- **Authorized official phone:** (310) 453-3312

## Contact information

- **Practice address:** 1301 20TH ST, \#290, SANTA MONICA, CA 90404
- **Practice address phone:** (310) 453-3312
- **Practice address fax:** (310) 453-3808
- **Mailing address:** 2461 SANTA MONICA BLVD, \#336, SANTA MONICA, CA 90404
- **Mailing address phone:** (310) 453-3312
- **Mailing address fax:** (310) 453-3808

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207RE0101X | Endocrinology, Diabetes & Metabolism Physician | A71398 | CA | Yes |

## Other

- **Enumeration date:** 05/16/2006
- **Last updated:** 08/22/2020