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Amanda Jo Moore

Psychiatry & Neurology

Allopathic & Osteopathic Physicians

1920 Marengo St, Exodus Recovery, Los Angeles, CA 90033

PECOS Enrollment

This provider is enrolled in PECOS as AMANDA POST.

Based on the most recent information from CMS, provider Amanda Jo Moore is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.

Part B
Medicare Part B
Enrolled
HHA
Home Health Agency
Enrolled
DME
Durable Medical Equipment
Enrolled
PMD
Power Mobility Device
Enrolled

CMS last updated its PECOS records 2 days ago.

Profile Details

Provider ID
1568611358
Provider Type
Individual
Full Name
Moore, Amanda Jo
Title
Dr.
Credential
DO

Gender
Female
Sole Proprietor
Yes
Enumeration Date
9/16/2008
Last Updated
8/17/2021

Contact Information

Practice Location

1920 Marengo St, Exodus Recovery, Los Angeles, CA 90033

(323) 276-6400

(858) 822-0231

Mailing Location

9808 Venice Blvd, Exodus Recovery, Culver City, CA 90232

(310) 945-3350

(858) 822-0231

Provider Taxonomies

Code	Description	License
Code 2084P0800X Primary	Description Psychiatry & Neurology Allopathic & Osteopathic Physicians	License 11045 California

Amanda Jo Moore

PECOS Enrollment

Profile Details

Contact Information

Practice Location

Mailing Location

Provider Taxonomies

Code

Description

License

Code

Description

License

Jandial, Sonal

Ashraf, Huzaifa

Wagreich, Eric

Lu, Yvonne

Ruppert, Ryan

Stager, Kelli

Sassano-Higgins, Sean

Nguyen, Han

Lopez, Danielle Anne

Kendall, Laura Kristen