MEDICARE: ALEX MORENO, M.D., MEDICAL GROUP, 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	207R00000X	Internal Medicine Physician	A78052	CA

General Provider Information

NPI Number	:	1679701320
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALEX MORENO, M.D., MEDICAL GROUP, INC

Provider Business Mailing Address
First Line	:	1523 E AMAR RD
Second Line	:	SUITE E
City	:	WEST COVINA
State	:	CA
Zip	:	91792-1619
Country	:	US
Telephone Number	:	626-839-9100
Fax Number	:	626-839-9106

Provider Business Practice Location Address
First Line	:	1523 E AMAR RD
Second Line	:	SUITE E
City	:	WEST COVINA
State	:	CA
Zip	:	91792-1619
Country	:	US
Telephone Number	:	626-839-9100
Fax Number	:	626-839-9106

Authorized Official
Title or Position	:	DIRECTOR
Name	:	SHURA A. MORENO
Credential	:	M.D.
Telephone Number	:	626-839-9100

Provider Enumeration Date	:	07/01/2009
Last Update Date	:	10/14/2009

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