Individual
ELISA AMELIA MORENO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD (MBBS)
Contact information
Practice address
1520 SAN PABLO ST STE 1652, LOS ANGELES, CA 90033-5310
(323) 442-6000
Mailing address
PO BOX 31309, LOS ANGELES, CA 90031-0309
(323) 442-5100
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
A96429
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00A964290
—
CA
Enumeration date
09/26/2007
Last updated
07/30/2021
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