Provider Demographics
NPI:1750766150
Name:MORENO, ANGEL LEONEL (NP)
Entity type:Individual
Prefix:MR
First Name:ANGEL
Middle Name:LEONEL
Last Name:MORENO
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1149 N WESTMORELAND AVE APT 14
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90029-1923
Mailing Address - Country:US
Mailing Address - Phone:213-595-3314
Mailing Address - Fax:
Practice Address - Street 1:300 UCLA MEDICAL PLZ
Practice Address - Street 2:SUITE B-200
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90095-8346
Practice Address - Country:US
Practice Address - Phone:310-794-1195
Practice Address - Fax:310-794-7491
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-27
Last Update Date:2015-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA950013532084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology