Individual
IVANA MORENO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
445 N SAN JOAQUIN ST, STOCKTON, CA 95202-2026
(209) 444-8910
Mailing address
445 N SAN JOAQUIN ST, STOCKTON, CA 95202-2026
Taxonomy
Speciality
Code
Description
License number
State
172V00000X
Community Health Worker
Primary
—
—
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
09/05/2023
Last updated
04/11/2024
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