Provider Demographics
NPI:1780931931
Name:MORENO, ANGELA LUISA
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:LUISA
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 1:5246 FLORENCE AVE SPC 85
Mailing Address - Street 2:
Mailing Address - City:CUDAHY
Mailing Address - State:CA
Mailing Address - Zip Code:90201-8505
Mailing Address - Country:US
Mailing Address - Phone:323-602-3492
Mailing Address - Fax:
Practice Address - Street 1:5255 POMONA BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90022-1753
Practice Address - Country:US
Practice Address - Phone:323-888-2530
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-07
Last Update Date:2012-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)