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General NPI Number Information
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NPI Number | 1295198992
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Entity Type | Individual
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Provider Name | PAUL DANIEL MORENO SR. SUDCC IV, BA, MA
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Gender | Male
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Dates
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Enumeration Date | 03/30/2016
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Last Update Date | 07/03/2025
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Provider Practice Location Address
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Address Line | 900 QUEBEC AVE
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City | CORCORAN
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State | CA
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Zip | 93212-9715
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Country | US
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Telephone | 559-992-7100
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Fax |
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Provider Business Mailing Address
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Address Line | 900 QUEBEC AVE
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City | CORCORAN
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State | CA
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Zip | 93212-9715
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Country | US
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Telephone | 559-992-7100
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | A051500118
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 5933
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 151516
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License Number State | CA
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Taxonomy #4
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Taxonomy Code | 172V00000X
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Taxonomy Name | Community Health Worker
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 18430
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License Number State | CA
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