Provider Demographics
NPI:1295597383
Name:CB MORENO
Entity type:Organization
Organization Name:CB MORENO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:
Authorized Official - Last Name:MORENO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:941-625-0117
Mailing Address - Street 1:18198 SUMMERDOWN AVE
Mailing Address - Street 2:
Mailing Address - City:PORT CHARLOTTE
Mailing Address - State:FL
Mailing Address - Zip Code:33948-1921
Mailing Address - Country:US
Mailing Address - Phone:941-625-0117
Mailing Address - Fax:941-625-3116
Practice Address - Street 1:2765 TAMIAMI TRL STE E
Practice Address - Street 2:
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33952-5163
Practice Address - Country:US
Practice Address - Phone:941-625-0117
Practice Address - Fax:941-625-3116
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-25
Last Update Date:2024-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)