Provider Demographics
NPI:1609483924
Name:MORENO, AILEENA
Entity Type:Individual
Prefix:
First Name:AILEENA
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:PO BOX 1726
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:CA
Mailing Address - Zip Code:92684-1726
Mailing Address - Country:US
Mailing Address - Phone:714-750-9700
Mailing Address - Fax:714-750-9797
Practice Address - Street 1:12900B GARDEN GROVE BLVD STE 235
Practice Address - Street 2:
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92843-2027
Practice Address - Country:US
Practice Address - Phone:714-750-9700
Practice Address - Fax:714-750-9797
Is Sole Proprietor?:No
Enumeration Date:2020-09-30
Last Update Date:2022-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225X00000X
CA21880225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist