Individual
ANA DAISY MORENO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3075 MYERS ST, RIVERSIDE, CA 92503-5525
(951) 358-4625
Mailing address
16443 FREESIA CT, FONTANA, CA 92336-1464
(626) 482-1601
Taxonomy
Speciality
Code
Description
License number
State
106H00000X
Marriage & Family Therapist
Primary
—
—
171M00000X
Case Manager/Care Coordinator
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
93-0670286
—
CA
Enumeration date
04/04/2019
Last updated
06/26/2020
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