Provider Demographics
NPI:1659267961
Name:MOORE, TYLER JOURDAN (LVN)
Entity type:Individual
Prefix:
First Name:TYLER
Middle Name:JOURDAN
Last Name:MOORE
Suffix:
Gender:M
Credentials:LVN
Other - Prefix:
Other - First Name:TYLER
Other - Middle Name:JOURDAN
Other - Last Name:MOORE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LVN
Mailing Address - Street 1:38241 AUGUSTA DR
Mailing Address - Street 2:
Mailing Address - City:MURRIETA
Mailing Address - State:CA
Mailing Address - Zip Code:92563-5808
Mailing Address - Country:US
Mailing Address - Phone:951-438-3754
Mailing Address - Fax:
Practice Address - Street 1:1560 CAPALINA RD
Practice Address - Street 2:
Practice Address - City:SAN MARCOS
Practice Address - State:CA
Practice Address - Zip Code:92069-1288
Practice Address - Country:US
Practice Address - Phone:760-891-4435
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-13
Last Update Date:2025-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA741814164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse