MEDICARE: CB 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	343900000X	Non-emergency Medical Transport (VAN)

General Provider Information

NPI Number	:	1295597383
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CB MORENO

Provider Business Mailing Address
First Line	:	18198 SUMMERDOWN AVE
Second Line	:
City	:	PORT CHARLOTTE
State	:	FL
Zip	:	33948-1921
Country	:	US
Telephone Number	:	941-625-0117
Fax Number	:	941-625-3116

Provider Business Practice Location Address
First Line	:	2765 TAMIAMI TRL STE E
Second Line	:
City	:	PORT CHARLOTTE
State	:	FL
Zip	:	33952-5163
Country	:	US
Telephone Number	:	941-625-0117
Fax Number	:	941-625-3116

Authorized Official
Title or Position	:	OWNER
Name	:	CHARLES MORENO
Credential	:
Telephone Number	:	941-625-0117

Provider Enumeration Date	:	01/25/2024
Last Update Date	:	01/25/2024

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