MEDICARE: NYKEEA 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	106S00000X	Behavior Technician

General Provider Information

NPI Number	:	1205549623
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NYKEEA MORENO

Provider Business Mailing Address
First Line	:	2342 PROFESSIONAL PKWY STE 300
Second Line	:
City	:	SANTA MARIA
State	:	CA
Zip	:	93455-6819
Country	:	US
Telephone Number	:	805-979-9941
Fax Number	:

Provider Business Practice Location Address
First Line	:	1200 21ST ST
Second Line	:
City	:	BAKERSFIELD
State	:	CA
Zip	:	93301-4606
Country	:	US
Telephone Number	:	805-979-9941
Fax Number	:

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

Provider Enumeration Date	:	12/30/2022
Last Update Date	:	12/30/2022

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