Provider Demographics
NPI:1124821756
Name:MORENO-CORTEZ, KARLA BERENICE
Entity type:Individual
Prefix:
First Name:KARLA
Middle Name:BERENICE
Last Name:MORENO-CORTEZ
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8291 UTICA AVE STE 102
Mailing Address - Street 2:
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91730-3800
Mailing Address - Country:US
Mailing Address - Phone:909-727-2577
Mailing Address - Fax:
Practice Address - Street 1:8291 UTICA AVE STE 102
Practice Address - Street 2:
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730-3800
Practice Address - Country:US
Practice Address - Phone:909-727-2577
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-29
Last Update Date:2025-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA153216106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist