1912214354 NPI number — MARIA Y MORENO EDD, MSW

Table of content: MARIA Y MORENO EDD, MSW (NPI 1912214354)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1912214354 NPI number — MARIA Y MORENO EDD, MSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MORENO
Provider First Name:
MARIA
Provider Middle Name:
Y
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
EDD, MSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1912214354
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/25/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
154A W FOOTHILL BLVD # 421
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
UPLAND
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91786-3847
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
909-758-2175
Provider Business Mailing Address Fax Number:
909-736-3481

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
600 N MOUNTAIN AVE STE C205B
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
UPLAND
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91786-4315
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
909-758-2175
Provider Business Practice Location Address Fax Number:
909-736-3481
Provider Enumeration Date:
09/07/2010

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103T00000X , with the licence number:  30681 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 103TC0700X , with the licence number: 30681 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)