Individual
ROSLYN MOORE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
3132 W ALTA VISTA RD, PHOENIX, AZ 85041-5209
(623) 873-0204
Mailing address
3132 W ALTA VISTA RD, PHOENIX, AZ 85041-5209
(623) 873-0204
Taxonomy
Speciality
Code
Description
License number
State
385HR2055X
Child Mental Illness Respite Care
Primary
8559
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
917057
AHCCCS ID
AZ
Enumeration date
11/29/2006
Last updated
07/08/2007
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