Provider Demographics
NPI:1477865715
Name:MORENO, ROSA
Entity Type:Individual
Prefix:
First Name:ROSA
Middle Name:
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 1:1258 S PLYMOUTH BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90019-6886
Mailing Address - Country:US
Mailing Address - Phone:213-985-5756
Mailing Address - Fax:562-591-0071
Practice Address - Street 1:2008 PACIFIC AVE
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90806-4610
Practice Address - Country:US
Practice Address - Phone:562-591-0011
Practice Address - Fax:562-591-0071
Is Sole Proprietor?:No
Enumeration Date:2010-07-01
Last Update Date:2010-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)