MEDICARE: MISS CINDY CAROLINA MORAN MSWI

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	374700000X	Technician

General Provider Information

NPI Number	:	1780719914
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS CINDY CAROLINA MORAN MSWI

Provider Business Mailing Address
First Line	:	253 FANSHAW AVE
Second Line	:
City	:	POMONA
State	:	CA
Zip	:	91767-1409
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2990 INLAND EMPIRE BLVD
Second Line	:	SUITE 101
City	:	ONTARIO
State	:	CA
Zip	:	91764-4899
Country	:	US
Telephone Number	:	909-980-3427
Fax Number	:	909-945-3426

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

Provider Enumeration Date	:	02/21/2007
Last Update Date	:	07/08/2007

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