Healthcare Provider Details

I. General information

NPI: 1811045388
Provider Name (Legal Business Name): JOEL ANGEL MORENO CATC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/08/2007
Last Update Date: 01/04/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16940 HIGHWAY 14 STE C-J
MOJAVE CA
93501-1238
US

IV. Provider business mailing address

16940 HIGHWAY 14 STE C-J
MOJAVE CA
93501-1238
US

V. Phone/Fax

Practice location:
  • Phone: 661-824-5020
  • Fax:
Mailing address:
  • Phone: 661-824-5020
  • Fax: 661-824-5026

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberM1001060918
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: