Doctor Name: | MR. HENRY MORENO |
NPI Number: | 1154443455 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | |
License Number: | |
Business Practice Address: | 500 West Hospital Road French Camp, CA - 95231 |
Business Phone Number: | 2094686862 |
Business Fax Number: | 2094687032 |
Mailing Address: | 850 W Sneed Rd, FRENCH CAMP |
State: | CA |
Postal Code: | 952319606 |
Phone Number: | 2099824901 |
Fax Number: | |
NPI Enumeration Date: | 04/06/2007 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YA0400X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Addiction (Substance Use Disorder) |
Taxonomy Definition: |