Individual
MADISON MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
4420 HOTEL CIRCLE CT STE 200, SAN DIEGO, CA 92108-3423
(619) 933-2165
Mailing address
5356 E KINGS AVE, SCOTTSDALE, AZ 85254-1123
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
085011506
IL
363A00000X
Physician Assistant
Primary
PA68382
CA
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
05/07/2024
Last updated
05/15/2026
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