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General NPI Number Information
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NPI Number | 1669110987
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Entity Type | Individual
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Provider Name | GISELLE MORENO
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Gender | Female
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Dates
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Enumeration Date | 05/25/2022
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Last Update Date | 06/03/2024
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Provider Practice Location Address
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Address Line | 1424 30TH ST STE A
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City | SAN DIEGO
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State | CA
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Zip | 92154-3417
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Country | US
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Telephone | 619-565-2650
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Fax |
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Provider Business Mailing Address
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Address Line | 1886 TOULOUSE DR
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City | CHULA VISTA
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State | CA
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Zip | 91913-2998
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Country | US
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Telephone | 619-600-7725
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 14778
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License Number State | CA
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Taxonomy #2
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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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