MEDICARE: C&C MORENO REGISTERED NURSING INC

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	363LF0000X	Family Nurse Practitioner

General Provider Information

NPI Number	:	1053975227
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	C&C MORENO REGISTERED NURSING INC

Provider Business Mailing Address
First Line	:	635 S WESTLAKE AVE STE 101
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90057-3525
Country	:	US
Telephone Number	:	213-674-7769
Fax Number	:

Provider Business Practice Location Address
First Line	:	635 S WESTLAKE AVE STE 101
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90057-3525
Country	:	US
Telephone Number	:	213-674-7769
Fax Number	:

Authorized Official
Title or Position	:	NURSE PRACTITIONER
Name	:	CLAUDIA MORENO
Credential	:	NP
Telephone Number	:	213-674-7769

Provider Enumeration Date	:	04/23/2019
Last Update Date	:	04/23/2019

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