MEDICARE: NOEL LENA MORENO PA-C

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	363AM0700X	Medical Physician Assistant	PA20592	CA

General Provider Information

NPI Number	:	1932434404
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NOEL LENA MORENO PA-C

Provider Business Mailing Address
First Line	:	1011 MIDDLEFIELD AVE
Second Line	:
City	:	STOCKTON
State	:	CA
Zip	:	95204-6205
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2633 PACIFIC AVE
Second Line	:
City	:	STOCKTON
State	:	CA
Zip	:	95204-4429
Country	:	US
Telephone Number	:	209-944-5530
Fax Number	:

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

Provider Enumeration Date	:	10/16/2009
Last Update Date	:	10/09/2012

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Directions to “ NOEL LENA MORENO PA-C” Practice Location

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