Individual provider Active NPI

Stacy Moon

  • Case Manager/Care Coordinator
  • Moreno Valley, CA
National Provider Identifier
1487210290
Registry record updated Apr 1, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Case Manager/Care CoordinatorTaxonomy code 171M00000X
Practice address
22445 Alessandro Blvd
Moreno Valley, CA 92553-8358
Phone
(951) 924-9791
NPI assigned
May 16, 2019
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 1, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Behavior Technician 106S00000X
Case Manager/Care Coordinator 171M00000X Primary

Addresses

Primary practice location

22445 Alessandro Blvd
Moreno Valley, CA 92553-8358

Mailing address

22445 Alessandro Blvd
Moreno Valley, CA 92553-8358
Phone (951) 924-9791

Other practice location 1

1508 W Artesia Sq Apt B
Gardena, CA 90248-4773
Phone (800) 249-1266

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)
Not enrolled

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1557964800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1585699200000",
    "number": "1487210290",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "22445 ALESSANDRO BLVD",
            "city": "MORENO VALLEY",
            "state": "CA",
            "postal_code": "925538358",
            "telephone_number": "951-924-9791"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "22445 ALESSANDRO BLVD",
            "city": "MORENO VALLEY",
            "state": "CA",
            "postal_code": "925538358",
            "telephone_number": "951-924-9791"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1508 W Artesia Sq Apt B",
            "address_purpose": "LOCATION",
            "city": "Gardena",
            "state": "CA",
            "postal_code": "902484773",
            "country_code": "US",
            "telephone_number": "800-249-1266",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MOON",
        "first_name": "STACY",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-05-16",
        "last_updated": "2020-04-01",
        "certification_date": "2020-04-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106S00000X",
            "taxonomy_group": "",
            "desc": "Behavior Technician",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "171M00000X",
            "taxonomy_group": "",
            "desc": "Case Manager/Care Coordinator",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Moreno Valley, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 1, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.