Individual
MR. BLAKE MICHAEL MORENO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
17831 AUTRY CT, CHINO HILLS, CA 91709-3281
(951) 444-5140
Mailing address
762 CYPRESS ST, SAN DIMAS, CA 91773-3505
(909) 573-9748
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
115717
CA
Other
Enumeration date
08/19/2013
Last updated
07/18/2023
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