Active NPI
Stephanie Moore, PSYD
- Clinical Neuropsychologist
- Santa Ana, CA
National Provider Identifier
1225032865
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Neuropsychologist
- License
- PSY14222
- Practice address
- 801 N Tustin Ave
#603
Santa Ana, CA 92705-3612 - Phone
- (714) 731-6231
- Fax
- (714) 731-6283
- NPI assigned
- Jun 10, 2005
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Neuropsychologist | 103G00000X | PSY14222 | CA | Primary |
Addresses
Primary practice location
801 N Tustin Ave
#603
Santa Ana, CA 92705-3612
Mailing address
24992 Katie Ave
Laguna Hills, CA 92053
Phone (949) 280-7984
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| PSY14222 | Other | CA | LICENSE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1118361600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1273622400000",
"number": "1225032865",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "24992 KATIE AVE",
"city": "LAGUNA HILLS",
"state": "CA",
"postal_code": "92053",
"telephone_number": "949-280-7984",
"fax_number": "949-474-1174"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "801 N TUSTIN AVE",
"address_2": "#603",
"city": "SANTA ANA",
"state": "CA",
"postal_code": "927053612",
"telephone_number": "714-731-6231",
"fax_number": "714-731-6283"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MOORE",
"first_name": "STEPHANIE",
"credential": "PSYD",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2005-06-10",
"last_updated": "2010-05-12",
"status": "A"
},
"taxonomies": [
{
"code": "103G00000X",
"taxonomy_group": "",
"desc": "Clinical Neuropsychologist",
"state": "CA",
"license": "PSY14222",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "LICENSE",
"identifier": "PSY14222",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Santa Ana, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 12, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.