Provider Demographics
NPI:1295464170
Name:MORENO, BRANDY (RN)
Entity Type:Individual
Prefix:
First Name:BRANDY
Middle Name:
Last Name:MORENO
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1034 S TERRI ANN DR
Mailing Address - Street 2:
Mailing Address - City:WEST COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91791-3653
Mailing Address - Country:US
Mailing Address - Phone:626-634-7515
Mailing Address - Fax:
Practice Address - Street 1:2040 CAMFIELD AVE
Practice Address - Street 2:
Practice Address - City:COMMERCE
Practice Address - State:CA
Practice Address - Zip Code:90040-1502
Practice Address - Country:US
Practice Address - Phone:323-725-8751
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-07
Last Update Date:2022-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95228482163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management