Healthcare Provider Details

I. General information

NPI: 1447933767
Provider Name (Legal Business Name): ROSAURA MORENO MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/11/2023
Last Update Date: 08/11/2023
Certification Date: 08/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4310 ORANGE ST
RIVERSIDE CA
92501-3829
US

IV. Provider business mailing address

3400 CENTRAL AVE STE 235
RIVERSIDE CA
92506-2175
US

V. Phone/Fax

Practice location:
  • Phone: 951-781-6335
  • Fax: 951-781-6365
Mailing address:
  • Phone: 714-770-9924
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number94857
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: