Provider Demographics
NPI:1891562310
Name:MORENO, SARAHJOY (NP)
Entity Type:Individual
Prefix:
First Name:SARAHJOY
Middle Name:
Last Name:MORENO
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:SARAH
Other - Middle Name:
Other - Last Name:SALAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:426 VILLAGE WAY
Mailing Address - Street 2:
Mailing Address - City:BREA
Mailing Address - State:CA
Mailing Address - Zip Code:92821-3067
Mailing Address - Country:US
Mailing Address - Phone:323-599-2352
Mailing Address - Fax:
Practice Address - Street 1:3006 SAN GABRIEL BLVD
Practice Address - Street 2:
Practice Address - City:ROSEMEAD
Practice Address - State:CA
Practice Address - Zip Code:91770-2536
Practice Address - Country:US
Practice Address - Phone:626-773-8900
Practice Address - Fax:626-940-5225
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-05
Last Update Date:2024-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95015402363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health