Provider Demographics
NPI:1326319542
Name:MORENO, ELIZABETH A (CASE MANAGER)
Entity Type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:A
Last Name:MORENO
Suffix:
Gender:F
Credentials:CASE MANAGER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10200 LEHIGH AVE,
Mailing Address - Street 2:
Mailing Address - City:MONTCLAIR
Mailing Address - State:CA
Mailing Address - Zip Code:91763-3550
Mailing Address - Country:US
Mailing Address - Phone:909-445-1618
Mailing Address - Fax:909-445-1620
Practice Address - Street 1:10200 LEHIGH AVE,
Practice Address - Street 2:
Practice Address - City:MONTCLAIR
Practice Address - State:CA
Practice Address - Zip Code:91763-3550
Practice Address - Country:US
Practice Address - Phone:909-445-1618
Practice Address - Fax:909-445-1620
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-19
Last Update Date:2012-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator