Individual
MARY MORENO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
HOME CARE AIDE
Contact information
Practice address
225 REDWOOD ST APT 23, SAN DIEGO, CA 92103-5668
(619) 643-5334
Mailing address
PO BOX 80906, SAN DIEGO, CA 92138-0906
Taxonomy
Speciality
Code
Description
License number
State
3747P1801X
Personal Care Attendant
Primary
7517414402
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
7517414402
DEPT OF SOCIAL SERVICES HOME CARE SERVICES BUREAU
CA
Enumeration date
08/02/2019
Last updated
08/02/2019
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