MEDICARE: MS. GERALDINE MORENO MFTI

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	64673	CA

General Provider Information

NPI Number	:	1841583077
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. GERALDINE MORENO MFTI

Provider Business Mailing Address
First Line	:	45175 PANORAMA DR
Second Line	:	SUITE B
City	:	PALM DESERT
State	:	CA
Zip	:	92260-4482
Country	:	US
Telephone Number	:	760-346-4665
Fax Number	:

Provider Business Practice Location Address
First Line	:	72710 E LYNN ST
Second Line	:
City	:	THOUSAND PALMS
State	:	CA
Zip	:	92276-3312
Country	:	US
Telephone Number	:	760-343-3211
Fax Number	:

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

Provider Enumeration Date	:	05/20/2011
Last Update Date	:	05/20/2011

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