Healthcare Provider Details

I. General information

NPI: 1427435064
Provider Name (Legal Business Name): CHERISSE MORENO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2015
Last Update Date: 12/08/2021
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 PEPPERMILL LN
POMONA CA
91766-4718
US

IV. Provider business mailing address

5 PEPPERMILL LN
POMONA CA
91766-4718
US

V. Phone/Fax

Practice location:
  • Phone: 909-816-2754
  • Fax:
Mailing address:
  • Phone: 909-816-2754
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number95000388
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: