Healthcare Provider Details

I. General information

NPI: 1588589345
Provider Name (Legal Business Name): SEBASTIAN MORENO MONTES RN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2026
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1205 W FOOTHILL BLVD
RIALTO CA
92376-4746
US

IV. Provider business mailing address

1205 W FOOTHILL BLVD
RIALTO CA
92376-4746
US

V. Phone/Fax

Practice location:
  • Phone: 833-867-4642
  • Fax:
Mailing address:
  • Phone: 909-543-6364
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number95381903
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: