| Doctor Name: | MR. MARIO ISRAEL MORENO |
| NPI Number: | 1215064555 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | |
| License Number: | |
| Business Practice Address: | 15229 Amar Rd La Puente, CA - 917442066 |
| Business Phone Number: | 6268555090 |
| Business Fax Number: | 6269611810 |
| Mailing Address: | 1350 S Candish Ave, GLENDORA |
| State: | CA |
| Postal Code: | 917405800 |
| Phone Number: | 6262602605 |
| Fax Number: | |
| NPI Enumeration Date: | 02/27/2007 |
| 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: | |