Individual
WESLEY S MOORE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
200 UCLA MEDICAL PLZ STE 526, LOS ANGELES, CA 90095-6908
(310) 267-0172
(310) 725-4037
Mailing address
5767 W CENTURY BLVD STE 400, LOS ANGELES, CA 90045-5631
Taxonomy
Speciality
Code
Description
License number
State
2086S0129X
Vascular Surgery Physician
Primary
A19266
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00A19266
BLUE SHIELD
CA
01
—
A19266
BLUE CROSS
CA
01
—
P00168682
MEDICARE PIN
CA
Enumeration date
07/26/2006
Last updated
12/20/2019
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