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Tisha Moore, PA
Surgical Physician Assistant in Los Angeles, California
NPI 1326067901

Tisha Moore is a Surgical Physician Assistant based in Los Angeles, CA and is specialized in Surgical. Tisha Moore practices in Los Angeles, CA and has the professional credentials of PA. The NPI Number for Tisha Moore is 1326067901 and holds a License No. PA16773 (California).

The current practice location address for Tisha Moore is 10833 Le Conte Ave, Los Angeles, CA and can be reached out via phone at 310-303-6204.

Location: 10833 Le Conte Ave, Los Angeles, CA, 90074-2939
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
person
Provider Profile Details
NPI Number
1326067901
Provider Name
Tisha Moore
Credential
PA
Provider Entity Type
Individual
Gender
Female
Address
10833 Le Conte Ave, Los Angeles, CA, 90074-2939
Phone Number
310-303-6204
Fax Number
Provider Enumeration Date
07/18/2006
Last Update Date
03/08/2024
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Provider's Legacy Identifiers
Identifier Type State Issuer
00PA167730 01 CA MEDI CAL
institution
Provider Business Practice Location Address Details
Address
10833 Le Conte Ave
City
Los Angeles
State
California
Zip
90095-3075
Phone Number
310-303-6204
Fax Number
person
Provider Business Mailing Address Details
Address
10833 Le Conte Ave
City
Los Angeles
State
California
Zip
90095-3075
Phone Number
310-303-6204
Fax Number
person
Provider's Taxonomy Details 1
Type
Allopathic & Osteopathic Physicians
Classification
Urology
Speciality
-
Taxonomy
208800000X
License No.
PA16773 (California)
Definition
A urologist manages benign and malignant medical and surgical disorders of the genitourinary system and the adrenal gland. This specialist has comprehensive knowledge of and skills in endoscopic, percutaneous and open surgery of congenital and acquired conditions of the urinary and reproductive systems and their contiguous structures.
person
Provider's Taxonomy Details 2
Type
Physician Assistants & Advanced Practice Nursing Providers
Classification
Physician Assistant
Speciality
Surgical
Taxonomy
363AS0400X
License No.
PA16773 (California)
Definition
Definition to come...
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