Individual
TRACY MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1335 CYPRESS ST STE 100, SAN DIMAS, CA 91773-3538
(909) 305-1383
(909) 305-1435
Mailing address
PO BOX 99, SAN DIMAS, CA 91773-0099
(909) 305-1383
(909) 305-1435
Taxonomy
Speciality
Code
Description
License number
State
2081S0010X
Sports Medicine (Physical Medicine & Rehabilitation) Physician
Primary
298059
CA
Other
Enumeration date
02/18/2020
Last updated
02/18/2020
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