Basic Information
| Provider Information | |||||||||
| NPI: | 1811045388 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MORENO | ||||||||
| FirstName: | JOEL | ||||||||
| MiddleName: | ANGEL | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | CATC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 16940 HIGHWAY 14 STE C-J | ||||||||
| Address2: | |||||||||
| City: | MOJAVE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 935011238 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6618245020 | ||||||||
| FaxNumber: | 6618245026 | ||||||||
| Practice Location | |||||||||
| Address1: | 16940 HIGHWAY 14 STE C-J | ||||||||
| Address2: | |||||||||
| City: | MOJAVE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 935011238 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6618245020 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/08/2007 | ||||||||
| LastUpdateDate: | 01/04/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | M1001060918 | CA | Y | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
No ID Information.