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Provider Information for 1689706327

Please Note: Issuance of an NPI does not ensure or validate that the Health Care Provider is Licensed or Credentialed. For more information please refer to NPI: What You Need to Know

DR. GERARDO MORENO MD, MSHS

Gender: MALE

Individual NPI: 1689706327

Calendar   Last Updated:  2019-12-20
  Certification Date:  2019-12-20

Details

Name Value
NPI 1689706327
Enumeration Date 2007-03-09
NPI Type 1 - Individual
Sole Proprietor NO
Status Active
Mailing Address 5767 W CENTURY BLVD STE 400
LOS ANGELES, CA 90045-5631
United States

Phone: | Fax:
View Map External Link
Primary Practice Address 1920 COLORADO AVE
SANTA MONICA, CA 90404-3414
United States

Phone: 310-319-4700 | Fax: 310-453-5106
View Map External Link
Health Information Exchange
Endpoint Type Endpoint Endpoint Description Use Content Type Affiliation Endpoint Location
Other Identifiers
Issuer State Number
MEDICAID CA 00A945030
Taxonomy
Primary Taxonomy Selected Taxonomy State License Number
Yes 207Q00000X - Family Medicine CA A94503