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General NPI Number Information
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NPI Number | 1316779077
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Entity Type | Organization
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Legal Business Name | ANGELA MORENO
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Dates
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Enumeration Date | 08/20/2024
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Last Update Date | 10/28/2024
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Provider Practice Location Address
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Address Line | 5121 STOCKDALE HWY
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City | BAKERSFIELD
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State | CA
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Zip | 93309-2656
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Country | US
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Telephone | 661-868-6840
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Fax |
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Provider Business Mailing Address
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Address Line | 5025 TIERRA ABIERTA DR
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City | BAKERSFIELD
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State | CA
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Zip | 93307-8341
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Country | US
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Telephone | 661-308-8250
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Fax |
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Authorized Official
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Title or Position | VOLUNTEER
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Name | ANGELA A MORENO
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Credential |
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Telephone | 661-308-8250
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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