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NPI Code Detail

MEDICARE: LARRY MORENO

MEDICARE: LARRY 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
1103K00000XBehavior AnalystFL

General Provider Information

NPI Number : 1689969214
Entity Type Code : Individual
Provider Name (Legal Business Name) : LARRY MORENO
Provider Business Mailing Address
First Line : 3520 OAKS WAY #904
Second Line :
City : POMPANO BEACH
State : FL
Zip : 33069
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 3520 OAKS WAY APT 904
Second Line :
City : POMPANO BEACH
State : FL
Zip : 33069-5387
Country : US
Telephone Number : 305-807-1909
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/11/2011
Last Update Date : 02/19/2014

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Directions to “ LARRY MORENO ” Practice Location

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