Individual
DAMIAN DARRYL MOORE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LPT
Contact information
Practice address
1481 WINDSOR DR, SAN BERNARDINO, CA 92404-5416
(909) 361-6470
Mailing address
5604 N E ST, SAN BERNARDINO, CA 92407-2626
(909) 341-3865
Taxonomy
Speciality
Code
Description
License number
State
167G00000X
Licensed Psychiatric Technician
Primary
42031
CA
Other
Enumeration date
05/16/2022
Last updated
05/16/2022
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