MEDICARE: PATRICIA 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	101YA0400X	Addiction (Substance Use Disorder) Counselor	RW3257	CA

General Provider Information

NPI Number	:	1710290531
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PATRICIA MORENO

Provider Business Mailing Address
First Line	:	7822 RADFORD AVE
Second Line	:
City	:	NORTH HOLLYWOOD
State	:	CA
Zip	:	91605-2515
Country	:	US
Telephone Number	:	818-691-4818
Fax Number	:

Provider Business Practice Location Address
First Line	:	7822 RADFORD AVE
Second Line	:
City	:	NORTH HOLLYWOOD
State	:	CA
Zip	:	91605-2515
Country	:	US
Telephone Number	:	818-691-4818
Fax Number	:

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

Provider Enumeration Date	:	07/21/2010
Last Update Date	:	07/21/2010

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Directions to “ PATRICIA MORENO ” Practice Location

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