MEDICARE: DR. ALEXIS A MORENO PSB94029593

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	106H00000X	Marriage & Family Therapist	IMF61735	CA
2	103T00000X	Psychologist	PSB94029593	CA

General Provider Information

NPI Number	:	1356667141
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ALEXIS A MORENO PSB94029593

Provider Business Mailing Address
First Line	:	4140 OCEANSIDE BLVD STE 1591182
Second Line	:
City	:	OCEANSIDE
State	:	CA
Zip	:	92056-6005
Country	:	US
Telephone Number	:	760-606-2601
Fax Number	:

Provider Business Practice Location Address
First Line	:	2683 STATE ST
Second Line	:
City	:	CARLSBAD
State	:	CA
Zip	:	92008-1627
Country	:	US
Telephone Number	:	760-814-9379
Fax Number	:

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

Provider Enumeration Date	:	04/19/2010
Last Update Date	:	05/16/2026

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