Provider Demographics
NPI:1932364593
Name:MORONEZ, IMELDA CG (MSW)
Entity Type:Individual
Prefix:MRS
First Name:IMELDA
Middle Name:CG
Last Name:MORONEZ
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 312
Mailing Address - Street 2:
Mailing Address - City:COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91723-0312
Mailing Address - Country:US
Mailing Address - Phone:626-327-5838
Mailing Address - Fax:
Practice Address - Street 1:4024 DURFEE AVE
Practice Address - Street 2:WING D
Practice Address - City:EL MONTE
Practice Address - State:CA
Practice Address - Zip Code:91732-2510
Practice Address - Country:US
Practice Address - Phone:626-279-2530
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-23
Last Update Date:2016-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAASW 29135101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA7565AOtherOUTPATIENT MENTAL HEALTH