Healthcare Provider Details

I. General information

NPI: 1598443616
Provider Name (Legal Business Name): SAVANNAH MORENO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2023
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

209 N K ST
TULARE CA
93274-4005
US

IV. Provider business mailing address

1127 W WALNUT AVE
VISALIA CA
93277-5337
US

V. Phone/Fax

Practice location:
  • Phone: 559-972-5729
  • Fax:
Mailing address:
  • Phone: 559-972-5729
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberASW140940
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: