Provider Demographics
NPI:1932113503
Name:MORENO, PEDRO ANGEL (MD)
Entity Type:Individual
Prefix:DR
First Name:PEDRO
Middle Name:ANGEL
Last Name:MORENO
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1615 BUNKER HILL WAY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SALINAS
Mailing Address - State:CA
Mailing Address - Zip Code:93906-6013
Mailing Address - Country:US
Mailing Address - Phone:831-769-1304
Mailing Address - Fax:831-757-0291
Practice Address - Street 1:559 E ALISAL ST
Practice Address - Street 2:SUITE 201
Practice Address - City:SALINAS
Practice Address - State:CA
Practice Address - Zip Code:93905-2516
Practice Address - Country:US
Practice Address - Phone:831-769-8800
Practice Address - Fax:831-422-9312
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2011-04-08
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Provider Licenses
StateLicense IDTaxonomies
CAA56024207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG84489Medicare UPIN
CAZZZ15686ZMedicare ID - Type UnspecifiedCOUNTY OF MONTEREY GROUP