Darryl Kenneth Moore, PHD

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

PSY22459 Issued in CA

Practice address

3110 Camino del Rio S Ste 220
San Diego, CA 92108

Phone

(858) 433-8751

Fax

(858) 433-0118

NPI assigned

Sep 7, 2006

Sex

Male

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)

Enrolled

Credentials

Doctor of Philosophy

State licenses

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

{
    "created_epoch": "1157587200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1538006400000",
    "number": "1861595423",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3110 CAMINO DEL RIO S STE 220",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921083831",
            "telephone_number": "858-433-8751",
            "fax_number": "858-433-0118"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3110 CAMINO DEL RIO S STE 220",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "92108",
            "telephone_number": "858-433-8751",
            "fax_number": "858-433-0118"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4540 Kearny Villa Rd",
            "address_2": "Suite 206",
            "address_purpose": "LOCATION",
            "city": "San Diego",
            "state": "CA",
            "postal_code": "921231571",
            "country_code": "US",
            "telephone_number": "858-433-8751",
            "fax_number": "858-433-0188",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MOORE",
        "first_name": "DARRYL",
        "middle_name": "KENNETH",
        "name_prefix": "Dr.",
        "credential": "PHD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-09-07",
        "last_updated": "2018-09-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TA0400X",
            "taxonomy_group": "",
            "desc": "Psychologist, Addiction (Substance Use Disorder)",
            "state": "CA",
            "license": "PSY22459",
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "CA",
            "license": "PSY22459",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Cinta Latrece Moore
• Colleen Moore, AU.D.
• Courtney Moore
• Courtney Danielle Moore, LCSW
• Courtney Diane Moore, RADT
• Donald Joe Moore, M.D.
• Eileen Moore
• Fiona Moore
• Gene P Moore, DDS
• Grace Moore

• Clinical Psychologist in San Diego, CA
• Providers in San Diego, CA by specialty
• Clinical Psychologist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 27, 2018; 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.