Provider Demographics
NPI:1992812358
Name:BLESSING-MOORE, JOANN C (MD)
Entity type:Individual
Prefix:
First Name:JOANN
Middle Name:C
Last Name:BLESSING-MOORE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5 QUAIL MEADOW DR
Mailing Address - Street 2:
Mailing Address - City:WOODSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:94062-2499
Mailing Address - Country:US
Mailing Address - Phone:650-688-8480
Mailing Address - Fax:650-688-8483
Practice Address - Street 1:723 EMERSON ST
Practice Address - Street 2:
Practice Address - City:PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94301-2411
Practice Address - Country:US
Practice Address - Phone:650-688-8480
Practice Address - Fax:650-688-8483
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-23
Last Update Date:2015-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG26617207K00000X
CAG-266172080P0214X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
No2080P0214XAllopathic & Osteopathic PhysiciansPediatricsPediatric Pulmonology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAC04156Medicare UPIN
CA00G266170Medicare ID - Type UnspecifiedMEDICARE NUMBER