Provider Demographics
NPI:1316693914
Name:MORENO, DON
Entity type:Individual
Prefix:
First Name:DON
Middle Name:
Last Name:MORENO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4059 PICCIOLA RD LOT 59
Mailing Address - Street 2:
Mailing Address - City:FRUITLAND PARK
Mailing Address - State:FL
Mailing Address - Zip Code:34731-6453
Mailing Address - Country:US
Mailing Address - Phone:352-874-5104
Mailing Address - Fax:
Practice Address - Street 1:201 E MAGNOLIA AVE
Practice Address - Street 2:
Practice Address - City:EUSTIS
Practice Address - State:FL
Practice Address - Zip Code:32726-3583
Practice Address - Country:US
Practice Address - Phone:352-357-1550
Practice Address - Fax:352-357-1103
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-23
Last Update Date:2022-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)