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Individual
DONNIE JAY MORENO I
Active
Individual
DONNIE JAY MORENO I
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Taxonomy
Speciality
Code
Description
License number
State
163WW0000X
Wound Care Registered Nurse
8CB9E
CA
2081S0010X
Sports Medicine (Physical Medicine & Rehabilitation) Physician
Primary
1051707
CA
225400000X
Rehabilitation Practitioner
1051707
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1051707
—
CA
01
—
8CB9E
BASIC LIFE SUPPORT
CA
Enumeration date
12/20/2023
Last updated
01/29/2024
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