Provider Demographics
NPI:1861009193
Name:MORENO, SAMANTHA REBECCA
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:REBECCA
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 1:200 PINE AVE STE 400
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90802-3039
Mailing Address - Country:US
Mailing Address - Phone:562-676-0759
Mailing Address - Fax:
Practice Address - Street 1:200 PINE AVE STE 400
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90802-3039
Practice Address - Country:US
Practice Address - Phone:562-676-0759
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-30
Last Update Date:2020-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator