Healthcare Provider Details

I. General information

NPI: 1528481124
Provider Name (Legal Business Name): MISS ANGELICA MORENO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/03/2014
Last Update Date: 02/03/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2637 W BURREL AVE
VISALIA CA
93291-4511
US

IV. Provider business mailing address

PO BOX 5091
VISALIA CA
93278-5091
US

V. Phone/Fax

Practice location:
  • Phone: 559-747-0115
  • Fax:
Mailing address:
  • Phone: 559-757-0115
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: