Provider Demographics
NPI:1588287098
Name:MORENO, PIA MAE SANGALANG
Entity type:Individual
Prefix:MS
First Name:PIA MAE
Middle Name:SANGALANG
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 1:21501 S VERMONT AVE APT 105
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90502-1914
Mailing Address - Country:US
Mailing Address - Phone:424-308-3767
Mailing Address - Fax:
Practice Address - Street 1:13128 IMPERIAL HWY
Practice Address - Street 2:
Practice Address - City:SANTA FE SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:90670-4817
Practice Address - Country:US
Practice Address - Phone:562-941-9595
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-19
Last Update Date:2020-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA177030183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician