Provider Demographics
NPI:1760103857
Name:VENALONZO MORENO, VERONICA (MSW INTERN)
Entity Type:Individual
Prefix:MRS
First Name:VERONICA
Middle Name:
Last Name:VENALONZO MORENO
Suffix:
Gender:F
Credentials:MSW INTERN
Other - Prefix:MRS
Other - First Name:VERONICA
Other - Middle Name:
Other - Last Name:PONCE MORENO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MSW INTERN
Mailing Address - Street 1:PO BOX 326
Mailing Address - Street 2:
Mailing Address - City:TRAVER
Mailing Address - State:CA
Mailing Address - Zip Code:93673-0326
Mailing Address - Country:US
Mailing Address - Phone:559-792-8905
Mailing Address - Fax:
Practice Address - Street 1:1002 N DOUTY ST
Practice Address - Street 2:
Practice Address - City:HANFORD
Practice Address - State:CA
Practice Address - Zip Code:93230-3723
Practice Address - Country:US
Practice Address - Phone:559-792-8905
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-07
Last Update Date:2022-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker