MEDICARE: MARIA VICTORIA MORENO M.A.

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	IMF 53381	CA

General Provider Information

NPI Number	:	1629109368
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARIA VICTORIA MORENO M.A.

Provider Business Mailing Address
First Line	:	8300 S VERMONT AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90044-3422
Country	:	US
Telephone Number	:	323-965-6170
Fax Number	:	323-789-3363

Provider Business Practice Location Address
First Line	:	8300 S VERMONT AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90044-3422
Country	:	US
Telephone Number	:	323-965-6170
Fax Number	:	323-789-3363

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

Provider Enumeration Date	:	03/07/2007
Last Update Date	:	05/29/2012

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