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Individual
ILIANA MORENO
Active
Individual
ILIANA MORENO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Taxonomy
Speciality
Code
Description
License number
State
172V00000X
Community Health Worker
—
—
225400000X
Rehabilitation Practitioner
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
95-263376
MEDI-CAL
CA
Enumeration date
08/26/2024
Last updated
09/25/2024
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