Provider Demographics
NPI:1093054256
Name:MORENO, TASHA (BCBA)
Entity Type:Individual
Prefix:
First Name:TASHA
Middle Name:
Last Name:MORENO
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3731 6TH AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92103-4383
Mailing Address - Country:US
Mailing Address - Phone:619-977-7201
Mailing Address - Fax:619-374-7134
Practice Address - Street 1:1330 QUAIL LAKE LOOP STE 120
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80906-4651
Practice Address - Country:US
Practice Address - Phone:619-977-7201
Practice Address - Fax:619-374-7134
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-07
Last Update Date:2013-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COBCBA: 1-13-13886103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst