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NPI Code Detail

MEDICARE: MARIANA MORENO

MEDICARE: MARIANA MORENO
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
1101YA0400XAddiction (Substance Use Disorder) Counselor

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MAOTHERCAMEDICAL ASSISTANT

General Provider Information

NPI Number : 1508155961
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARIANA MORENO
Provider Business Mailing Address
First Line : 6265 SEPULVEDA BLVD STE 9
Second Line :
City : VAN NUYS
State : CA
Zip : 91411-1126
Country : US
Telephone Number : 818-779-0555
Fax Number : 818-779-0455
Provider Business Practice Location Address
First Line : 6265 SEPULVEDA BLVD STE 9
Second Line :
City : VAN NUYS
State : CA
Zip : 91411-1126
Country : US
Telephone Number : 818-779-0555
Fax Number : 818-779-0455
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/06/2011
Last Update Date : 04/06/2011

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Directions to “ MARIANA MORENO ” Practice Location

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