Healthcare Provider Details

I. General information

NPI: 1942166335
Provider Name (Legal Business Name): JOSE MORENO CUETO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: JOSE ARMANDO MORENO

II. Dates (important events)

Enumeration Date: 12/29/2025
Last Update Date: 12/29/2025
Certification Date: 12/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1548 W 60TH ST
LOS ANGELES CA
90047-1215
US

IV. Provider business mailing address

1548 W 60TH ST
LOS ANGELES CA
90047-1215
US

V. Phone/Fax

Practice location:
  • Phone: 310-780-8353
  • Fax:
Mailing address:
  • Phone: 310-780-8353
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: