Healthcare Provider Details

I. General information

NPI: 1477975449
Provider Name (Legal Business Name): GABRIEL MORENO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/10/2014
Last Update Date: 05/26/2026
Certification Date: 05/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1323 BLUEBONNET AVE
VENTURA CA
93004-3568
US

IV. Provider business mailing address

1323 BLUEBONNET AVE UNIT A
VENTURA CA
93004-3568
US

V. Phone/Fax

Practice location:
  • Phone: 805-760-3088
  • Fax: 702-500-1218
Mailing address:
  • Phone: 805-760-3088
  • Fax: 702-500-1218

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-13-13660
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: