Provider Demographics
NPI:1477975449
Name:MORENO, GABRIEL
Entity Type:Individual
Prefix:
First Name:GABRIEL
Middle Name:
Last Name:MORENO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3001 MISSION OAKS BLVD
Mailing Address - Street 2:UNIT A
Mailing Address - City:CAMARILLO
Mailing Address - State:CA
Mailing Address - Zip Code:93012-8710
Mailing Address - Country:US
Mailing Address - Phone:805-383-5566
Mailing Address - Fax:888-659-0031
Practice Address - Street 1:3001 MISSION OAKS BLVD
Practice Address - Street 2:UNIT A
Practice Address - City:CAMARILLO
Practice Address - State:CA
Practice Address - Zip Code:93012-8710
Practice Address - Country:US
Practice Address - Phone:805-383-5566
Practice Address - Fax:888-659-0031
Is Sole Proprietor?:No
Enumeration Date:2014-01-10
Last Update Date:2014-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1-13-13660103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst