Provider Demographics
NPI:1841477403
Name:MORENO, ARLENE SUSAN PENTECOSTES (MS, RD)
Entity type:Individual
Prefix:
First Name:ARLENE SUSAN
Middle Name:PENTECOSTES
Last Name:MORENO
Suffix:
Gender:F
Credentials:MS, RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:557 WILLOW PL
Mailing Address - Street 2:
Mailing Address - City:LA VERNE
Mailing Address - State:CA
Mailing Address - Zip Code:91750-5744
Mailing Address - Country:US
Mailing Address - Phone:626-643-6335
Mailing Address - Fax:
Practice Address - Street 1:557 WILLOW PL
Practice Address - Street 2:
Practice Address - City:LA VERNE
Practice Address - State:CA
Practice Address - Zip Code:91750-5744
Practice Address - Country:US
Practice Address - Phone:626-643-6335
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-01-25
Last Update Date:2008-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered