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General NPI Number Information
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NPI Number | 1285171827
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Entity Type | Individual
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Provider Name | CICELY MORENO M.D.
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Gender | Female
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Dates
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Enumeration Date | 01/20/2017
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Last Update Date | 01/16/2026
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Provider Practice Location Address
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Address Line | 4 LONGMEADOW VILLAGE DR
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City | NILES
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State | MI
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Zip | 49120-7809
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Country | US
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Telephone | 269-684-6000
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Fax |
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Provider Business Mailing Address
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Address Line | 4 LONGMEADOW VILLAGE DR
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City | NILES
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State | MI
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Zip | 49120-7809
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Country | US
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Telephone | 269-684-6000
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207QA0401X
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Taxonomy Name | Addiction Medicine (Family Medicine) Physician
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License Number | 4301509637
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 01083223A
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License Number State | IN
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