Healthcare Provider Details

I. General information

NPI: 1356667141
Provider Name (Legal Business Name): ALEXIS A MORENO PSB94029593
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/19/2010
Last Update Date: 05/16/2026
Certification Date: 05/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2683 STATE ST
CARLSBAD CA
92008-1627
US

IV. Provider business mailing address

4140 OCEANSIDE BLVD STE 1591182
OCEANSIDE CA
92056-6005
US

V. Phone/Fax

Practice location:
  • Phone: 760-814-9379
  • Fax:
Mailing address:
  • Phone: 760-606-2601
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberIMF61735
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPSB94029593
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: