Individual
JACOB RYAN MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
10821 FAIR OAKS BLVD, FAIR OAKS, CA 95628-7214
(916) 903-7028
Mailing address
2609 K ST APT 11, SACRAMENTO, CA 95816-5112
(916) 230-5613
Taxonomy
Speciality
Code
Description
License number
State
164X00000X
Licensed Vocational Nurse
Primary
722770
CA
Other
Enumeration date
03/08/2024
Last updated
03/08/2024
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