MEDICARE: ELIZABETH M 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
1	2355S0801X	Speech-Language Assistant	5998	CA

General Provider Information

NPI Number	:	1679163604
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELIZABETH M MORENO

Provider Business Mailing Address
First Line	:	2114 IRONBARK CIR
Second Line	:
City	:	BREA
State	:	CA
Zip	:	92821-4417
Country	:	US
Telephone Number	:	714-244-2785
Fax Number	:

Provider Business Practice Location Address
First Line	:	1700 SANTA FE AVE # 832
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90813-1200
Country	:	US
Telephone Number	:	562-410-9799
Fax Number	:

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

Provider Enumeration Date	:	01/23/2021
Last Update Date	:	01/23/2021

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Directions to “ ELIZABETH M MORENO ” Practice Location

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