Provider Demographics
NPI:1043615610
Name:MORENO FAMILY MEDICAL AND ASSOCIATES INC
Entity Type:Organization
Organization Name:MORENO FAMILY MEDICAL AND ASSOCIATES INC
Other - Org Name:CHINO HILLS FAMILY MEDICAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:
Authorized Official - Last Name:MORENO
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:909-393-7171
Mailing Address - Street 1:15361 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:CHINO
Mailing Address - State:CA
Mailing Address - Zip Code:91710-7608
Mailing Address - Country:US
Mailing Address - Phone:909-393-7171
Mailing Address - Fax:
Practice Address - Street 1:15361 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:CHINO
Practice Address - State:CA
Practice Address - Zip Code:91710-7608
Practice Address - Country:US
Practice Address - Phone:909-393-7171
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-24
Last Update Date:2020-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A8031207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty