Provider Demographics
NPI:1063253615
Name:MOORE, SAHARI ISABEL
Entity type:Individual
Prefix:
First Name:SAHARI
Middle Name:ISABEL
Last Name:MOORE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SAHARI
Other - Middle Name:ISABEL
Other - Last Name:RECENDIZ-LAMAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8118 1/4 CHESTNUT AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH GATE
Mailing Address - State:CA
Mailing Address - Zip Code:90280
Mailing Address - Country:US
Mailing Address - Phone:213-544-7250
Mailing Address - Fax:
Practice Address - Street 1:506 W GRAHAM AVE SUITE 106
Practice Address - Street 2:
Practice Address - City:LAKE ILSINORE
Practice Address - State:CA
Practice Address - Zip Code:92530
Practice Address - Country:US
Practice Address - Phone:888-638-8457
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-05
Last Update Date:2024-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMPSS-LUOECV175T00000X
CA172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
No175T00000XOther Service ProvidersPeer Specialist