Provider Demographics
NPI:1073795035
Name:MORONES, IRENE S
Entity type:Individual
Prefix:
First Name:IRENE
Middle Name:S
Last Name:MORONES
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 1:4083 N PEACH AVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93727-8421
Mailing Address - Country:US
Mailing Address - Phone:559-268-4800
Mailing Address - Fax:
Practice Address - Street 1:2855 W WHITESBRIDGE AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93706-1231
Practice Address - Country:US
Practice Address - Phone:559-268-4800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-12-03
Last Update Date:2007-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)