Healthcare Provider Details

I. General information

NPI: 1770551921
Provider Name (Legal Business Name): RICARDO J. MORENO MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/14/2006
Last Update Date: 04/02/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 WASHINTGON ST #701
SAN DIEGO CA
92103
US

IV. Provider business mailing address

550 WASHINTGON ST #701
SAN DIEGO CA
92103
US

V. Phone/Fax

Practice location:
  • Phone: 619-297-0008
  • Fax: 619-297-2498
Mailing address:
  • Phone: 619-297-0008
  • Fax: 619-297-2498

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberA30738
License Number StateCA

VIII. Authorized Official

Name: DR. RICARDO J MORENO
Title or Position: PRESIDENT
Credential: MD
Phone: 619-297-0008