Provider Demographics
NPI:1992798706
Name:MOORE, DEBORA MARIE (PA C)
Entity type:Individual
Prefix:
First Name:DEBORA
Middle Name:MARIE
Last Name:MOORE
Suffix:
Gender:F
Credentials:PA C
Other - Prefix:
Other - First Name:DEBORA
Other - Middle Name:
Other - Last Name:MOELLENBERNDT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:116 S PALISADE DR STE 210
Mailing Address - Street 2:
Mailing Address - City:SANTA MARIA
Mailing Address - State:CA
Mailing Address - Zip Code:93454-8906
Mailing Address - Country:US
Mailing Address - Phone:805-934-2488
Mailing Address - Fax:805-934-2480
Practice Address - Street 1:116 S PALISADE DR STE 210
Practice Address - Street 2:
Practice Address - City:SANTA MARIA
Practice Address - State:CA
Practice Address - Zip Code:93454-8906
Practice Address - Country:US
Practice Address - Phone:805-934-2488
Practice Address - Fax:805-934-2480
Is Sole Proprietor?:No
Enumeration Date:2005-08-26
Last Update Date:2023-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPA.966363A00000X
NC101190363AM0700X
CAPA53892363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant