Provider Demographics
NPI:1699800136
Name:MOORE, BURL RODDY (BS DEGREE PSYC)
Entity type:Individual
Prefix:MR
First Name:BURL
Middle Name:RODDY
Last Name:MOORE
Suffix:
Gender:M
Credentials:BS DEGREE PSYC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5317 S CORNING AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90056-1105
Mailing Address - Country:US
Mailing Address - Phone:310-787-1500
Mailing Address - Fax:310-787-9713
Practice Address - Street 1:5317 CORNING AVE.
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90056
Practice Address - Country:US
Practice Address - Phone:310-787-1500
Practice Address - Fax:310-787-9713
Is Sole Proprietor?:No
Enumeration Date:2007-02-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker