Provider Demographics
NPI:1124368709
Name:MORENO, GREG
Entity Type:Individual
Prefix:
First Name:GREG
Middle Name:
Last Name:MORENO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:410 E 7TH ST STE 9
Mailing Address - Street 2:
Mailing Address - City:HANFORD
Mailing Address - State:CA
Mailing Address - Zip Code:93230-4606
Mailing Address - Country:US
Mailing Address - Phone:559-584-8100
Mailing Address - Fax:559-585-2008
Practice Address - Street 1:410 E 7TH ST STE 9
Practice Address - Street 2:
Practice Address - City:HANFORD
Practice Address - State:CA
Practice Address - Zip Code:93230-4606
Practice Address - Country:US
Practice Address - Phone:559-584-8100
Practice Address - Fax:559-585-2008
Is Sole Proprietor?:No
Enumeration Date:2013-02-19
Last Update Date:2013-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)