MEDICARE: CRISTAL MORENO M.S.

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	106S00000X	Behavior Technician		CA

General Provider Information

NPI Number	:	1184167371
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CRISTAL MORENO M.S.

Provider Business Mailing Address
First Line	:	PO BOX 740780
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30374-0780
Country	:	US
Telephone Number	:	855-223-7123
Fax Number	:

Provider Business Practice Location Address
First Line	:	3604B FAIR OAKS BLVD, STE 200
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95864
Country	:	US
Telephone Number	:	855-223-7123
Fax Number	:

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

Provider Enumeration Date	:	11/21/2016
Last Update Date	:	02/02/2026

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Directions to “ CRISTAL MORENO M.S.” Practice Location

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