Basic Information
| Provider Information | |||||||||
| NPI: | 1023455524 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MORENO | ||||||||
| FirstName: | JENIFFER | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4501 N BELLFLOWER BLVD | ||||||||
| Address2: | APT 4 | ||||||||
| City: | LONG BEACH | ||||||||
| State: | CA | ||||||||
| PostalCode: | 908081252 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5622096441 | ||||||||
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| Practice Location | |||||||||
| Address1: | 11741 TELEGRAPH RD | ||||||||
| Address2: | |||||||||
| City: | SANTA FE SPRINGS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 906703681 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5628010318 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/24/2013 | ||||||||
| LastUpdateDate: | 05/24/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 164X00000X | 267640 | CA | Y | Nursing Service Providers | Licensed Vocational Nurse |
No ID Information.