DR. THEODORE BRUCE MOORE (NPI# 1710091020) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1710091020 |
| Entity Type | Individual |
| Full Name | DR. THEODORE BRUCE MOORE |
| Credential | M.D. |
| Practice Address |
10833 Le Conte Ave 12-441 Mdcc Los Angeles CA 90095-3075 |
| Practice Telephone | 3108256708 |
| Practice Fax Number | 3102068089 |
| Mailing Telephone | 3108256708 |
| Mailing Fax Number | 3102068089 |
| Enumeration Date | 2006-08-17 |
| Last Update Date | 2012-08-27 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2080P0207X |
Pediatrics Specialization: Pediatric Hematology-Oncology |
G69308 | CA | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| CA | 00G693080 | 05 | |
| CA | GR0053510 | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1134290695 | Theodore A Moore | Counselor | 2 Tree Farm Road, Suite B 220, Pennington, NJ 08534-3620 | 2006-11-13 |
| 1497756027 | Theodore English Moore | Dentist | 9896 Rosemont Ave, Ste 204, Lone Tree, CO 80124 | 2005-08-04 |
| 1164481552 | Theodore Craig Moore | Physical Therapist | 250 Elm Ave, Auburn, CA 95603-4226 | 2006-03-23 |
| Street Address |
10833 LE CONTE AVE 12-441 MDCC |
| City | LOS ANGELES |
| State | CA |
| Zip Code | 90095-3075 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1598761942 | Dennis Goldfinger | Specialist | 10833 Le Conte Ave, Los Angeles, CA 90095-3075 | 2005-06-21 |
| 1972129427 | Matthew Joseph Heinz | Student in an Organized Health Care Education/Training Program | 10833 Le Conte Ave, Los Angeles, CA 90095-3075 | 2020-06-21 |
| 1255955803 | Airton D Soares | Student in an Organized Health Care Education/Training Program | 10833 Le Conte Ave, Los Angeles, CA 90095-3075 | 2020-05-29 |
| 1073137626 | Gonzalo Nicolas Olaverria Salavaggione | Student in an Organized Health Care Education/Training Program | 10833 Le Conte Ave, Los Angeles, CA 90095-3075 | 2020-05-29 |
| 1780204990 | Maira Hinojosa | Student in an Organized Health Care Education/Training Program | 10833 Le Conte Ave, Los Angeles, CA 90095-3075 | 2020-04-17 |
| 1053930537 | Jeong Min Kim | Student in an Organized Health Care Education/Training Program | 10833 Le Conte Ave, Los Angeles, CA 90095-3075 | 2020-04-14 |
| 1972122778 | Mojan Mirnia | Student in an Organized Health Care Education/Training Program | 10833 Le Conte Ave, Los Angeles, CA 90095-3075 | 2020-04-11 |
| 1902435779 | Kaitlin Elizabeth Fusco | Student in an Organized Health Care Education/Training Program | 10833 Le Conte Ave, Los Angeles, CA 90095-3075 | 2020-04-03 |
| 1487283313 | Jonathan Douglas Gatto | Student in an Organized Health Care Education/Training Program | 10833 Le Conte Ave, Los Angeles, CA 90095-3075 | 2020-04-02 |
| 1578191839 | Abhishek Venkataramana | Student in an Organized Health Care Education/Training Program | 10833 Le Conte Ave, Los Angeles, CA 90095-1430 | 2020-03-31 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1982212155 | Alexandra Gubin | Social Worker | Ucla, 757 Westwood Medical Plaza, Los Angeles, CA 90095 | 2020-07-14 |
| 1952926263 | Georgina Parra | Student in an Organized Health Care Education/Training Program | 10833 Le Conteave, Los Angeles, CA 90095 | 2020-06-11 |
| 1609403575 | Yagmur Muftuoglu | Student in an Organized Health Care Education/Training Program | 757 Westwood Plaza, Neurosurgery, Los Angeles, CA 90095 | 2020-03-23 |
| 1619438173 | Brandon Covington Smith | Student in an Organized Health Care Education/Training Program | 727 Westwood Plaza, Dept of Internal Medicine, Los Angeles, CA 90095 | 2019-03-27 |
| 1184184913 | Alexander Daniel Yuen | Student in an Organized Health Care Education/Training Program | 757 Westwood Plaza (internal Medicine), Los Angeles, CA 90095 | 2019-03-19 |
| 1790266369 | Dana Saifan | Student in an Organized Health Care Education/Training Program | 1000 Veteran Avenue, Los Angeles, CA 90095 | 2018-08-22 |
| 1427549146 | Courtney Renee' Real | Registered Nurse | 757 Westwood Plz Ste 6236, Los Angeles, CA 90095 | 2018-05-29 |
| 1932605094 | Akash Atul Shah | Student in an Organized Health Care Education/Training Program | Ucla Department of Orthopaedic Surgery, 10833 Le Conte Avenue, 76-116 Chs, Los Angeles, CA 90095 | 2018-04-05 |
| 1316443435 | Dane Jensen Brodke | Orthopaedic Surgery | 757 Westwood Plaza, (orthopaedic Surgery), Los Angeles, CA 90095 | 2018-04-05 |
| 1477058824 | Thomas William Gaither Castellanos | Student in an Organized Health Care Education/Training Program | 757 Westwood Plaza, Urology, Los Angeles, CA 90095 | 2018-03-28 |
| Find all providers in zip 90095 | ||||
| Taxonomy Code | 2080P0207X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Pediatrics |
| Specialization | Pediatric Hematology-Oncology |
| A pediatrician trained in the combination of pediatrics, hematology and oncology to recognize and manage pediatric blood disorders and cancerous diseases. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Pediatrics, 2007. http://www.abp.org/. American Osteopathic Board of Pediatrics, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Pediatrics. Board certification for Doctors of Osteopathy (DOs) was provided by the American Osteopathic Board of Pediatrics. The Certification is no longer offered. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1457991143 | George Michaiel | Pediatrics | 4650 Sunset Blvd., Ms #54, Los Angeles, CA 90027 | 2020-01-09 |
| 1700012317 | Paibel Ixia Aguayo-hiraldo | Pediatrics | 4650 W Sunset Blvd # M54, Los Angeles, CA 90027 | 2009-06-09 |
| 1578746889 | Toska J Zomorodian | Pediatrics | 4650 W Sunset Blvd # 54, Los Angeles, CA 90027-6062 | 2007-12-10 |
| 1861512881 | Michael Marvin Siegel | Pediatrics | 2716 Creston Dr, Los Angeles, CA 90068-2210 | 2007-03-31 |
| 1225107410 | Robert Charles Seeger | Pediatrics | 4650 W Sunset Blvd # 57, Los Angeles, CA 90027-6062 | 2006-11-06 |
| 1144223926 | Fariba Navid | Pediatrics | 4650 W Sunset Blvd, Los Angeles, CA 90027-6062 | 2005-05-24 |
| 1386275881 | Jennifer Haas | Pediatrics | 4650 W Sunset Blvd, Los Angeles, CA 90027-6062 | 2020-02-03 |
| 1588097950 | Vasilios Berdoukas | Pediatrics | 4650 W Sunset Blvd, Los Angeles, CA 90027-6062 | 2013-08-20 |
| 1255770046 | Kristiyana Ivanova Kaneva | Pediatrics | 4650 W Sunset Blvd, Los Angeles, CA 90027-6062 | 2013-06-14 |
| 1730522194 | Theodore Scott Nowicki | Pediatrics | 200 Ucla Medical Plz Ste 265, Los Angeles, CA 90095 | 2013-04-16 |
| Find all providers in LOS ANGELES | ||||
| City | LOS ANGELES |
| Zip Code | 90095 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.