Provider Demographics
NPI:1447973904
Name:MORENO, DURAN JESUS
Entity type:Individual
Prefix:
First Name:DURAN
Middle Name:JESUS
Last Name:MORENO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10708 SHELLYFIELD RD
Mailing Address - Street 2:
Mailing Address - City:DOWNEY
Mailing Address - State:CA
Mailing Address - Zip Code:90241-2819
Mailing Address - Country:US
Mailing Address - Phone:562-544-7496
Mailing Address - Fax:
Practice Address - Street 1:10708 SHELLYFIELD RD
Practice Address - Street 2:
Practice Address - City:DOWNEY
Practice Address - State:CA
Practice Address - Zip Code:90241-2819
Practice Address - Country:US
Practice Address - Phone:562-544-7496
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-20
Last Update Date:2022-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician