Healthcare Provider Details

I. General information

NPI: 1740164763
Provider Name (Legal Business Name): NOEMY MORENO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2025
Last Update Date: 03/22/2026
Certification Date: 03/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23247 MAIN ST
CARSON CA
90745-5229
US

IV. Provider business mailing address

5151 STATE UNIVERSITY DR
LOS ANGELES CA
90032-4226
US

V. Phone/Fax

Practice location:
  • Phone: 310-429-0839
  • Fax:
Mailing address:
  • Phone: 323-343-3000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95036355
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: