Provider Demographics
NPI:1821043654
Name:MORENO, CECILIA CHAVEZ (MD)
Entity Type:Individual
Prefix:MS
First Name:CECILIA
Middle Name:CHAVEZ
Last Name:MORENO
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:7720 N FRESNO ST
Mailing Address - Street 2:SUITE 104
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93720-2407
Mailing Address - Country:US
Mailing Address - Phone:559-438-2300
Mailing Address - Fax:559-438-1531
Practice Address - Street 1:7720 N FRESNO ST
Practice Address - Street 2:SUITE 104
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720-2407
Practice Address - Country:US
Practice Address - Phone:559-438-2300
Practice Address - Fax:559-438-1531
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-23
Last Update Date:2015-10-07
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAA68973208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL00A689730Medicaid