Provider Demographics
NPI:1912351396
Name:MOORE, BRYAN (LVN)
Entity type:Individual
Prefix:
First Name:BRYAN
Middle Name:
Last Name:MOORE
Suffix:
Gender:M
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20423 VIA DON JUAN
Mailing Address - Street 2:
Mailing Address - City:YORBA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92886-3047
Mailing Address - Country:US
Mailing Address - Phone:714-650-6061
Mailing Address - Fax:
Practice Address - Street 1:245 VICTORIA ST
Practice Address - Street 2:SUITE 1H
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92627
Practice Address - Country:US
Practice Address - Phone:949-629-2860
Practice Address - Fax:949-629-2867
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-21
Last Update Date:2025-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA735990164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse