Provider Demographics
NPI:1316379274
Name:MORENO, KARINA VENEGAS
Entity Type:Individual
Prefix:
First Name:KARINA
Middle Name:VENEGAS
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 1:46900 MONROE ST STE 101A
Mailing Address - Street 2:
Mailing Address - City:INDIO
Mailing Address - State:CA
Mailing Address - Zip Code:92201-4828
Mailing Address - Country:US
Mailing Address - Phone:760-863-8708
Mailing Address - Fax:760-863-8777
Practice Address - Street 1:46900 MONROE ST STE 101A
Practice Address - Street 2:
Practice Address - City:INDIO
Practice Address - State:CA
Practice Address - Zip Code:92201
Practice Address - Country:US
Practice Address - Phone:760-863-8708
Practice Address - Fax:760-863-8777
Is Sole Proprietor?:No
Enumeration Date:2013-08-02
Last Update Date:2019-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health