Provider Demographics
NPI:1306575766
Name:MORENO, MARIA (CM)
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:
Last Name:MORENO
Suffix:
Gender:F
Credentials:CM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:225 WILDROSE LN
Mailing Address - Street 2:
Mailing Address - City:WINTERS
Mailing Address - State:CA
Mailing Address - Zip Code:95694-9084
Mailing Address - Country:US
Mailing Address - Phone:153-038-3015
Mailing Address - Fax:
Practice Address - Street 1:600 NUT TREE RD STE 310
Practice Address - Street 2:
Practice Address - City:VACAVILLE
Practice Address - State:CA
Practice Address - Zip Code:95687-4686
Practice Address - Country:US
Practice Address - Phone:707-359-1800
Practice Address - Fax:209-762-6808
Is Sole Proprietor?:No
Enumeration Date:2022-06-09
Last Update Date:2022-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator