Provider Demographics
NPI:1902227143
Name:MORENO, MARIA
Entity Type:Individual
Prefix:
First Name:MARIA
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 1:544 S SADLER AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90022-2730
Mailing Address - Country:US
Mailing Address - Phone:323-644-2000
Mailing Address - Fax:323-666-1417
Practice Address - Street 1:544 S SADLER AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90022-2730
Practice Address - Country:US
Practice Address - Phone:323-644-2000
Practice Address - Fax:323-666-1417
Is Sole Proprietor?:No
Enumeration Date:2013-12-13
Last Update Date:2013-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner