Individual
EVELYN MORENO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
400 N PEPPER AVE, COLTON, CA 92324-1801
(909) 580-3144
Mailing address
400 N PEPPER AVE, COLTON, CA 92324-1801
(909) 580-3144
Taxonomy
Speciality
Code
Description
License number
State
167G00000X
Licensed Psychiatric Technician
Primary
PT32689
CA
Other
Enumeration date
07/15/2009
Last updated
07/15/2009
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