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General NPI Number Information
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NPI Number | 1417156860
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Entity Type | Organization
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Legal Business Name | SHURA A MORENO MD
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Dates
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Enumeration Date | 07/16/2007
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Last Update Date | 07/16/2007
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Provider Practice Location Address
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Address Line | 4146 E OLYMPIC BLVD SUITE B
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City | LOS ANGELES
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State | CA
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Zip | 90023-3347
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Country | US
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Telephone | 323-262-9948
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Fax | 323-262-3708
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Provider Business Mailing Address
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Address Line | 4146 E OLYMPIC BLVD SUITE B
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City | LOS ANGELES
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State | CA
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Zip | 90023-3347
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Country | US
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Telephone | 323-262-9948
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Fax | 323-262-3708
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Authorized Official
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Title or Position | DIRECTOR
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Name | SHURA A MORENO
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Credential | MD
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Telephone | 323-262-9948
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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