Individual
JONATHAN MORENO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
3601 PACIFIC AVE, STOCKTON, CA 95211-0110
(209) 946-2588
Mailing address
20236 AVENA RD, ESCALON, CA 95320-9538
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
—
CA
Other
Enumeration date
10/03/2022
Last updated
10/03/2022
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