Provider Demographics
NPI:1285141663
Name:MORENO, CZRINA
Entity type:Individual
Prefix:
First Name:CZRINA
Middle Name:
Last Name:MORENO
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 1:116 W SHERMAN WAY STE 1
Mailing Address - Street 2:
Mailing Address - City:NIXA
Mailing Address - State:MO
Mailing Address - Zip Code:65714-9022
Mailing Address - Country:US
Mailing Address - Phone:172-980-9844
Mailing Address - Fax:173-747-1854
Practice Address - Street 1:7109 DANNY DR
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95210-5320
Practice Address - Country:US
Practice Address - Phone:209-957-7777
Practice Address - Fax:209-473-3344
Is Sole Proprietor?:No
Enumeration Date:2018-01-06
Last Update Date:2025-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MORBT-15-04535106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician