Individual
JEREMY PAUL MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
10833 LE CONTE AVE, B265, LOS ANGELES, CA 90095-3075
(310) 825-0867
(310) 825-9524
Mailing address
5767 W CENTURY BLVD, SUITE 400, LOS ANGELES, CA 90045-5631
(310) 825-5296
(310) 825-9524
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
A88084
CA
2080P0202X
Pediatric Cardiology Physician
A88084
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00A880840
—
CA
01
—
1265676274
CCS PANELED
CA
05
—
1265676274
—
CA
Enumeration date
04/22/2009
Last updated
06/08/2013
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