Individual
ALONZO MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1710 PENNSYLVANIA AVE, CHARLESTON, WV 25302-3934
(130) 434-8070
Mailing address
1710 PENNSYLVANIA AVE, CHARLESTON, WV 25302-3934
(130) 434-8070
Taxonomy
Speciality
Code
Description
License number
State
3747P1801X
Personal Care Attendant
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1255476511
—
WV
05
—
1982825972
—
WV
Enumeration date
08/18/2021
Last updated
08/18/2021
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