Individual
TISHA MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
PA16773
CA
363AS0400X
Surgical Physician Assistant
PA16773
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00PA167730
MEDI CAL
CA
Enumeration date
07/18/2006
Last updated
08/27/2012
Update your record
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