Provider Demographics
NPI:1275761686
Name:MORENO, DARLENE R
Entity Type:Individual
Prefix:
First Name:DARLENE
Middle Name:R
Last Name:MORENO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 11431
Mailing Address - Street 2:
Mailing Address - City:WHITTIER
Mailing Address - State:CA
Mailing Address - Zip Code:90603-0431
Mailing Address - Country:US
Mailing Address - Phone:562-715-9498
Mailing Address - Fax:
Practice Address - Street 1:1633 E 4TH ST
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92701-5163
Practice Address - Country:US
Practice Address - Phone:714-565-2830
Practice Address - Fax:714-565-2833
Is Sole Proprietor?:No
Enumeration Date:2009-06-24
Last Update Date:2011-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program