Provider Demographics
NPI:1518286186
Name:MORENO, ANGELICA MARIA
Entity Type:Individual
Prefix:MS
First Name:ANGELICA
Middle Name:MARIA
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 1:505 S 1ST AVE
Mailing Address - Street 2:APT. 3
Mailing Address - City:COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91723-3160
Mailing Address - Country:US
Mailing Address - Phone:626-343-1039
Mailing Address - Fax:
Practice Address - Street 1:505 S 1ST AVE
Practice Address - Street 2:APT. 3
Practice Address - City:COVINA
Practice Address - State:CA
Practice Address - Zip Code:91723-3160
Practice Address - Country:US
Practice Address - Phone:626-343-1039
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-05-21
Last Update Date:2010-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)