Provider Demographics
NPI:1124219183
Name:MORENO, SHERIE MARIE
Entity type:Individual
Prefix:MRS
First Name:SHERIE
Middle Name:MARIE
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 1:3917 LANDMARK LN
Mailing Address - Street 2:
Mailing Address - City:BREA
Mailing Address - State:CA
Mailing Address - Zip Code:92823-1026
Mailing Address - Country:US
Mailing Address - Phone:714-996-4462
Mailing Address - Fax:714-996-4842
Practice Address - Street 1:3917 LANDMARK LN
Practice Address - Street 2:
Practice Address - City:BREA
Practice Address - State:CA
Practice Address - Zip Code:92823-1026
Practice Address - Country:US
Practice Address - Phone:714-996-4462
Practice Address - Fax:714-996-4842
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-06
Last Update Date:2021-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIN PROGRESS363LW0102X, 367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health