Provider Demographics
NPI:1225864044
Name:MORENO, JASMIN MARCELL
Entity type:Individual
Prefix:
First Name:JASMIN
Middle Name:MARCELL
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 1:11061 WANDER DR
Mailing Address - Street 2:
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91730-0988
Mailing Address - Country:US
Mailing Address - Phone:909-254-1072
Mailing Address - Fax:
Practice Address - Street 1:11061 WANDER DR
Practice Address - Street 2:
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730-0988
Practice Address - Country:US
Practice Address - Phone:909-254-1072
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-09
Last Update Date:2024-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care