Provider Demographics
NPI:1295007771
Name:MORENO, MANUEL M
Entity Type:Individual
Prefix:MR
First Name:MANUEL
Middle Name:M
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 1:2933 N EL NIDO DR.
Mailing Address - Street 2:EL NIDO CAMPUS
Mailing Address - City:ALTADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91104
Mailing Address - Country:US
Mailing Address - Phone:626-395-7100
Mailing Address - Fax:
Practice Address - Street 1:2933 N EL NIDO DR.
Practice Address - Street 2:EL NIDO CAMPUS
Practice Address - City:ALTADENA
Practice Address - State:CA
Practice Address - Zip Code:91104
Practice Address - Country:US
Practice Address - Phone:626-395-7100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-01-31
Last Update Date:2012-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner