Healthcare Provider Details

I. General information

NPI: 1053715227
Provider Name (Legal Business Name): YOLANDA MORENO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/17/2014
Last Update Date: 08/24/2026
Certification Date: 08/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4000 W METROPOLITAN DR STE 401
ORANGE CA
92868-3506
US

IV. Provider business mailing address

4000 W METROPOLITAN DR STE 401
ORANGE CA
92868-3506
US

V. Phone/Fax

Practice location:
  • Phone: 866-830-6011
  • Fax: 714-954-2986
Mailing address:
  • Phone: 866-830-6011
  • Fax: 714-954-2986

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License NumberMPSS-VDOMUQ
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: