MEDICARE: EDWARD LAWRENCE MORENO M.D., M.P.H.

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	2083P0901X	Public Health & General Preventive Medicine Physician	G73496	CA
2	208000000X	Pediatrics Physician	G73496	CA

General Provider Information

NPI Number	:	1922136969
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EDWARD LAWRENCE MORENO M.D., M.P.H.

Provider Business Mailing Address
First Line	:	1270 NATIVIDAD RD
Second Line	:
City	:	SALINAS
State	:	CA
Zip	:	93906-3122
Country	:	US
Telephone Number	:	831-755-4585
Fax Number	:

Provider Business Practice Location Address
First Line	:	1270 NATIVIDAD RD
Second Line	:
City	:	SALINAS
State	:	CA
Zip	:	93906-3122
Country	:	US
Telephone Number	:	831-755-4797
Fax Number	:

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

Provider Enumeration Date	:	03/01/2007
Last Update Date	:	03/28/2016

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