| Doctor Name: | DR. JORGE LUIS MORENO |
| NPI Number: | 1306118393 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | D.O. |
| License Number: | 20A6911 |
| Business Practice Address: | 420 N Montebello Blvd Suite 300 Montebello, CA - 906404268 |
| Business Phone Number: | 3237266289 |
| Business Fax Number: | 3237266767 |
| Mailing Address: | 420 N Montebello Blvd, Suite 300 MONTEBELLO |
| State: | CA |
| Postal Code: | 906404268 |
| Phone Number: | 3237266289 |
| Fax Number: | 3237266767 |
| NPI Enumeration Date: | 02/06/2012 |
| NPI Last Update Date: | 02/06/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | 20A6911 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CA |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |