MEDICARE: MS. ROXANNE HORTA MORENO LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	LCSW69259	CA

General Provider Information

NPI Number	:	1053614727
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ROXANNE HORTA MORENO LCSW

Provider Business Mailing Address
First Line	:	2512 ARTESIA BLVD STE 300E
Second Line	:
City	:	REDONDO BEACH
State	:	CA
Zip	:	90278-3269
Country	:	US
Telephone Number	:	323-240-4450
Fax Number	:

Provider Business Practice Location Address
First Line	:	2512 ARTESIA BLVD STE 300E
Second Line	:
City	:	REDONDO BEACH
State	:	CA
Zip	:	90278-3269
Country	:	US
Telephone Number	:	323-240-4450
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/17/2010
Last Update Date	:	12/19/2019

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