Provider Demographics
NPI:1427458884
Name:MOORE, COLLEEN (AUD)
Entity type:Individual
Prefix:DR
First Name:COLLEEN
Middle Name:
Last Name:MOORE
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6727 FLANDERS DR
Mailing Address - Street 2:#204
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92121-2926
Mailing Address - Country:US
Mailing Address - Phone:858-863-6827
Mailing Address - Fax:858-630-2960
Practice Address - Street 1:6727 FLANDERS DR
Practice Address - Street 2:#204
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92121-2926
Practice Address - Country:US
Practice Address - Phone:858-863-6827
Practice Address - Fax:858-630-2960
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-03
Last Update Date:2014-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAU2862237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter