Individual
CASONDRA MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.O.
Contact information
Practice address
7330 N 99TH AVE STE 200A, GLENDALE, AZ 85307-3003
(623) 433-0202
Mailing address
3815 E BELL RD STE 2200, PHOENIX, AZ 85032-2139
(602) 633-3838
(602) 633-3845
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
L2258824
MI
207RC0000X
Cardiovascular Disease Physician
Primary
007657
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
449626
—
AZ
01
—
Z220861
MEDICARE
AZ
Enumeration date
06/19/2012
Last updated
04/29/2019
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