Marlyn Joanna Moore, MD

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

License

01084147A Issued in IN

Practice address

34800 Bob Wilson Dr
San Diego, CA 92134-1098

Phone

(619) 532-9660

NPI assigned

Apr 12, 2019

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Medicine

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

{
    "created_epoch": "1555027200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1786579200000",
    "number": "1821551060",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "34800 BOB WILSON DRIVE",
            "address_2": "DERMATOLOGY",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921340001",
            "telephone_number": "619-532-9660"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "34800 BOB WILSON DR",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921341098",
            "telephone_number": "619-532-9660"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOORE",
        "first_name": "MARLYN",
        "middle_name": "JOANNA",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-04-12",
        "last_updated": "2026-08-13",
        "certification_date": "2026-08-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "IN",
            "license": "01084147A",
            "primary": true
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "IN",
            "license": "01084247A",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Madison Moore
• Maricela Moore
• Marisa Moore
• Marissa Moore
• Marleen D.M Moore
• Matthew Pimentel Moore
• Page Staley Hope Moore, OTR/L
• Patricia Lynn Moore, M.A.
• Rachel Moore, LMFT
• Raeanne Moore, PH.D.

• Dermatology Physician in San Diego, CA
• Providers in San Diego, CA by specialty
• Dermatology Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 13, 2026; 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.