Physician Compare National (NPI:1376886457)

HEALTHCARE PROVIDER: GABRIEL MARIO MORENO M.D.

Physician Compare National contains general information about individual eligible professionals (EPs) such as demographic information and Medicare quality program participation.

Individual Professional Information
NPI	1376886457
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	1052669967
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20200406003123
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	MORENO
	Individual professional last name
Provider First Name	GABRIEL
	Individual professional first name
Provider Middle Name	M
	Individual professional middle name
Provider Gender	M
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	WAYNE STATE UNIVERSITY SCHOOL OF MEDICINE
	Individual professional's medical school
Graduation Year	2013
	Individual professional's medical school graduation year
Primary Specialty	NEUROLOGY
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Line 1 Street Address	1805 N CALIFORNIA ST
	Group Practice or individual's line 1 address
Line 2 Street Address	SUITE 201
	Group Practice or individual's line 2 address
City	STOCKTON
	Group Practice or individual's city
State	CA
	Group Practice or individual's state
Zip Code	952046032
	Group Practice or individual's zip code (9 digits when available)

Hospital(s) Affiliation Information
Hospital Affiliation CCN 1	050084
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	ST JOSEPHS MEDICAL CENTER OF STOCKTON
	Legal business name of hospital where individual professional provides service 1
Professional Accepts Medicare Assignment	Y