MEDICARE: TAWNY GLORIA MORENO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist	52897	CA

General Provider Information

NPI Number	:	1073820346
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TAWNY GLORIA MORENO

Provider Business Mailing Address
First Line	:	1690 W SHAW AVE STE 201
Second Line	:
City	:	FRESNO
State	:	CA
Zip	:	93711-3519
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1690 W SHAW AVE STE 201
Second Line	:
City	:	FRESNO
State	:	CA
Zip	:	93711-3519
Country	:	US
Telephone Number	:	855-343-1057
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/08/2010
Last Update Date	:	07/28/2021

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