Healthcare Provider Details

I. General information

NPI: 1780463984
Provider Name (Legal Business Name): KARLA VANESSA MORENO PEER SUPPORT SPEC.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/26/2023
Last Update Date: 07/03/2024
Certification Date: 06/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

142 E. CESAR CHAVEZ BLVD.
FRESNO CA
93706-3642
US

IV. Provider business mailing address

142 E. CESAR CHAVEZ BLVD.
FRESNO CA
93706-3642
US

V. Phone/Fax

Practice location:
  • Phone: 559-600-1033
  • Fax: 559-600-1101
Mailing address:
  • Phone: 559-600-1033
  • Fax: 559-600-1101

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License NumberTPHNYCVZUSEAWQIK
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License NumberTPHNYCZUSEAWQIK
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: