Provider Demographics
NPI:1861086142
Name:MOORE, TIARA (CPT)
Entity type:Individual
Prefix:MRS
First Name:TIARA
Middle Name:
Last Name:MOORE
Suffix:
Gender:F
Credentials:CPT
Other - Prefix:MS
Other - First Name:TIARA
Other - Middle Name:
Other - Last Name:TORRES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CPT
Mailing Address - Street 1:4204 LIND LN
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:VA
Mailing Address - Zip Code:23112-2628
Mailing Address - Country:US
Mailing Address - Phone:434-607-5905
Mailing Address - Fax:833-392-1187
Practice Address - Street 1:4204 LIND LN
Practice Address - Street 2:
Practice Address - City:MIDLOTHIAN
Practice Address - State:VA
Practice Address - Zip Code:23112-2628
Practice Address - Country:US
Practice Address - Phone:434-607-5905
Practice Address - Fax:833-392-1187
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-26
Last Update Date:2021-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA671110140005246RP1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomy