Individual
JENNIFER MORENO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
BA
Contact information
Practice address
1650 SPRUCE ST, RIVERSIDE, CA 92507-7402
(760) 634-1125
Mailing address
14742 ORCHID AVE, FONTANA, CA 92335-4263
(909) 714-8109
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Enumeration date
05/04/2018
Last updated
05/04/2018
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