Healthcare Provider Details

I. General information

NPI: 1205730645
Provider Name (Legal Business Name): DORINDA MORENO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: DORINDA DE TRINIDAD

II. Dates (important events)

Enumeration Date: 10/07/2026
Last Update Date: 10/07/2026
Certification Date: 10/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6905 HARRISON AVE
EASTVALE CA
92880-9324
US

IV. Provider business mailing address

13408 FRANCESCA CT
CHINO CA
91710-7314
US

V. Phone/Fax

Practice location:
  • Phone: 951-736-8241
  • Fax:
Mailing address:
  • Phone: 909-270-7510
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number220277797
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: