Organization
ASPIRANET
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ANGELICA MORENO LMFT 127640 (CLINICIAN IV)
(510) 735-6551
Entity
Organization
Contact information
Practice address
1620 CUMMINS DR, MODESTO, CA 95358-6400
(510) 735-6551
Mailing address
1620 CUMMINS DR, MODESTO, CA 95358-6400
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1871885467
—
CA
Enumeration date
03/04/2022
Last updated
03/04/2022
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