Provider Demographics
NPI:1144038688
Name:MOORAD, GENEVA A
Entity type:Individual
Prefix:
First Name:GENEVA
Middle Name:A
Last Name:MOORAD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:211 DORRIS PL
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95204-5252
Mailing Address - Country:US
Mailing Address - Phone:209-900-8733
Mailing Address - Fax:
Practice Address - Street 1:413 VILLA TICINO DR
Practice Address - Street 2:
Practice Address - City:MANTECA
Practice Address - State:CA
Practice Address - Zip Code:95337-6457
Practice Address - Country:US
Practice Address - Phone:209-990-8733
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-30
Last Update Date:2024-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251V00000XAgenciesVoluntary or Charitable
No372500000XNursing Service Related ProvidersChore Provider