Provider Demographics
NPI:1528263514
Name:MOORE, CECILIA ANN (RD, LD)
Entity type:Individual
Prefix:
First Name:CECILIA
Middle Name:ANN
Last Name:MOORE
Suffix:
Gender:F
Credentials:RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5865
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79408-5865
Mailing Address - Country:US
Mailing Address - Phone:806-743-2898
Mailing Address - Fax:806-743-2787
Practice Address - Street 1:3601 4TH ST
Practice Address - Street 2:STOP 9903
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79430-9903
Practice Address - Country:US
Practice Address - Phone:806-743-7337
Practice Address - Fax:806-743-7329
Is Sole Proprietor?:No
Enumeration Date:2007-06-19
Last Update Date:2025-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT80334133VN1004X, 133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133VN1004XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Pediatric
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM13785036Medicaid
TX8H8762OtherBC/BS
TX193439001Medicaid
TX8L25826Medicare PIN