Healthcare Provider Details

I. General information

NPI: 1851755847
Provider Name (Legal Business Name): JESSICA MORENO-WALKER MA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/06/2016
Last Update Date: 06/16/2023
Certification Date: 06/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27403 YNEZ RD STE 205
TEMECULA CA
92591-4616
US

IV. Provider business mailing address

27403 YNEZ RD STE 205
TEMECULA CA
92591-4616
US

V. Phone/Fax

Practice location:
  • Phone: 951-290-3103
  • Fax:
Mailing address:
  • Phone: 951-290-3103
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: