Individual
MR. SHANE M MOORE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MPSS-DSNBAR
Contact information
Practice address
12183 LOCKSLEY LN STE 101, AUBURN, CA 95602-2050
(530) 885-1961
Mailing address
12183 LOCKSLEY LN STE 101, AUBURN, CA 95602-2050
(530) 885-1961
Taxonomy
Speciality
Code
Description
License number
State
172V00000X
Community Health Worker
—
—
175T00000X
Peer Specialist
Primary
MPSS-DANBAR
CA
Other
Enumeration date
07/17/2023
Last updated
08/09/2024
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