Provider Demographics
NPI:1295198992
Name:MORENO, PAUL DANIEL SR (SUDCC III, BA)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:DANIEL
Last Name:MORENO
Suffix:SR
Gender:M
Credentials:SUDCC III, BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:153 N U ST
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93701-2438
Mailing Address - Country:US
Mailing Address - Phone:559-445-9094
Mailing Address - Fax:559-445-9083
Practice Address - Street 1:153 N U ST
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93701-2438
Practice Address - Country:US
Practice Address - Phone:559-445-9094
Practice Address - Fax:559-445-9083
Is Sole Proprietor?:No
Enumeration Date:2016-03-30
Last Update Date:2024-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA051500118101YA0400X
CA5933101YA0400X
172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)