Provider Demographics
NPI:1356230346
Name:MORESCO, CHARLENE ROBYN MEDINA
Entity type:Individual
Prefix:
First Name:CHARLENE ROBYN
Middle Name:MEDINA
Last Name:MORESCO
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 1:28341 WILLOW CT
Mailing Address - Street 2:
Mailing Address - City:SANTA CLARITA
Mailing Address - State:CA
Mailing Address - Zip Code:91350-4438
Mailing Address - Country:US
Mailing Address - Phone:818-817-1346
Mailing Address - Fax:
Practice Address - Street 1:980 ENCHANTED WAY STE 206
Practice Address - Street 2:
Practice Address - City:SIMI VALLEY
Practice Address - State:CA
Practice Address - Zip Code:93065-0913
Practice Address - Country:US
Practice Address - Phone:800-442-1558
Practice Address - Fax:805-581-0286
Is Sole Proprietor?:No
Enumeration Date:2025-07-02
Last Update Date:2025-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95035791363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily