# TIMOTHY R. MORENO, MD, INC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Moreno Urology
- **Organization subpart:** No

## Provider details

- **NPI number:** 1649710971
- **Authorized official:** TIMOTHY R MORENO M.D. (PRESIDENT)
- **Authorized official phone:** (209) 840-2575

## Contact information

- **Practice address:** 105 S FOREST RD, SONORA, CA 95370-4895
- **Practice address phone:** (209) 532-1255
- **Practice address fax:** (209) 532-8436
- **Mailing address:** 105 S FOREST RD, SONORA, CA 95370-4895
- **Mailing address phone:** (209) 532-1255
- **Mailing address fax:** (209) 532-8436

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QM2500X | Medical Specialty Clinic/Center | A45369 | CA | Yes |

## Other

- **Enumeration date:** 03/06/2017
- **Last updated:** 03/06/2017

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 00A453690 | — | CA |