Provider Demographics
NPI:1457158057
Name:MOORE, MARIA CHONA (FNP)
Entity type:Individual
Prefix:
First Name:MARIA CHONA
Middle Name:
Last Name:MOORE
Suffix:
Gender:
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1046 N HACIENDA BLVD
Mailing Address - Street 2:
Mailing Address - City:LA PUENTE
Mailing Address - State:CA
Mailing Address - Zip Code:91744-2059
Mailing Address - Country:US
Mailing Address - Phone:310-621-7253
Mailing Address - Fax:
Practice Address - Street 1:1617 WESTCLIFF DR STE 207
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-5526
Practice Address - Country:US
Practice Address - Phone:310-621-7253
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-01
Last Update Date:2025-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP95034034363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty