Individual
STEPHANIE MOORE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PSYD
Contact information
Practice address
801 N TUSTIN AVE, #603, SANTA ANA, CA 92705-3612
(714) 731-6231
(714) 731-6283
Mailing address
24992 KATIE AVE, LAGUNA HILLS, CA 92053
(949) 280-7984
(949) 474-1174
Taxonomy
Speciality
Code
Description
License number
State
103G00000X
Clinical Neuropsychologist
Primary
PSY14222
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PSY14222
LICENSE
CA
Enumeration date
06/10/2005
Last updated
05/12/2010
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